=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962465328
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALICIA F THOMAS ATC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/07/2006
-----------------------------------------------------
Last Update Date | 12/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2121 WILLOW ST
-----------------------------------------------------
City | VINCENNES
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47591-5355
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-882-1141
-----------------------------------------------------
Fax | 812-886-6333
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1302 N 12TH ST
-----------------------------------------------------
City | VINCENNES
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47591-3307
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-887-7733
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2255A2300X
-----------------------------------------------------
Taxonomy Name | Athletic Trainer
-----------------------------------------------------
License Number | 36000768A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225200000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Assistant
-----------------------------------------------------
License Number | 06004146A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------