MEDICARE: MRS. TORA MICHELLE THOMAS

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	225400000X	Rehabilitation Practitioner

General Provider Information

NPI Number	:	1306148010
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TORA MICHELLE THOMAS

Provider Business Mailing Address
First Line	:	4851 CONTENTO CIR
Second Line	:
City	:	N LAS VEGAS
State	:	NV
Zip	:	89031-5543
Country	:	US
Telephone Number	:	702-581-2851
Fax Number	:

Provider Business Practice Location Address
First Line	:	4538 W CRAIG RD
Second Line	:	SUITE #290
City	:	N LAS VEGAS
State	:	NV
Zip	:	89032-2508
Country	:	US
Telephone Number	:	702-581-2851
Fax Number	:

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

Provider Enumeration Date	:	12/01/2010
Last Update Date	:	12/01/2010

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