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General NPI Number Information
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NPI Number | 1760948962
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Entity Type | Individual
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Provider Name | QUANTAE THOMAS
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Gender | Female
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Dates
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Enumeration Date | 02/13/2019
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Last Update Date | 12/06/2022
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Provider Practice Location Address
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Address Line | 1910 PACIFIC AVE # 12015
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City | DALLAS
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State | TX
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Zip | 75201-4529
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Country | US
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Telephone | 214-727-5791
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Fax |
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Provider Business Mailing Address
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Address Line | 623 SIRIUS DR
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City | WAXAHACHIE
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State | TX
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Zip | 75165-2190
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Country | US
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Telephone | 214-727-5791
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1744P3200X
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Taxonomy Name | Prosthetics Case Management
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License Number |
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 1003125
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License Number State | TX
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