MEDICARE: KATHRYN WYNON THOMAS PT

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	225100000X	Physical Therapist	1131175	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1131175	OTHER	TX	PHYSICAL THERAPIST

General Provider Information

NPI Number	:	1255650271
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN WYNON THOMAS PT

Provider Business Mailing Address
First Line	:	322 SAINT GEORGE ST
Second Line	:
City	:	GONZALES
State	:	TX
Zip	:	78629-3912
Country	:	US
Telephone Number	:	830-672-7300
Fax Number	:	830-672-7302

Provider Business Practice Location Address
First Line	:	322 SAINT GEORGE ST
Second Line	:
City	:	GONZALES
State	:	TX
Zip	:	78629-3912
Country	:	US
Telephone Number	:	830-672-7300
Fax Number	:	830-672-7302

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

Provider Enumeration Date	:	06/01/2010
Last Update Date	:	06/01/2010

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