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NPI Code Detail

MEDICARE: JEREMY THOMAS ATC, DPT

MEDICARE: JEREMY THOMAS ATC, DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program
2225100000XPhysical TherapistPT027708PA

General Provider Information

NPI Number : 1134673221
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEREMY THOMAS ATC, DPT
Provider Business Mailing Address
First Line : 8946 MAIN ST APT 31
Second Line :
City : MC KEAN
State : PA
Zip : 16426-1462
Country : US
Telephone Number : 412-657-2927
Fax Number :
Provider Business Practice Location Address
First Line : 109 UNIVERSITY SQ
Second Line :
City : ERIE
State : PA
Zip : 16541-0002
Country : US
Telephone Number : 814-571-5300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/07/2016
Last Update Date : 09/22/2020

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