MEDICARE: RICHELLE CASIE THOMAS PTA

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
1	225200000X	Physical Therapy Assistant	4903	NC

General Provider Information

NPI Number	:	1184875940
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHELLE CASIE THOMAS PTA

Provider Business Mailing Address
First Line	:	PO BOX 2229
Second Line	:
City	:	FRANKLIN
State	:	NC
Zip	:	28744-2229
Country	:	US
Telephone Number	:	828-342-0104
Fax Number	:

Provider Business Practice Location Address
First Line	:	420 ORCHARD VIEW DR APT I
Second Line	:
City	:	FRANKLIN
State	:	NC
Zip	:	28734-7307
Country	:	US
Telephone Number	:	828-342-0104
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/09/2008
Last Update Date	:	10/09/2008

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