=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780130146
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARIAN THOMAS PT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/26/2016
-----------------------------------------------------
Last Update Date | 02/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 851 S MAIN ST
-----------------------------------------------------
City | HOLLY SPRINGS
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27540-8907
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-467-4991
-----------------------------------------------------
Fax | 919-557-6084
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5221 PARAMOUNT PKWY STE 220
-----------------------------------------------------
City | MORRISVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27560-5490
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | P16574
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------