MEDICARE: KAVITHA THOMAS P.T.

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	027756	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	027756	OTHER	NY	LICENSE

General Provider Information

NPI Number	:	1609078179
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAVITHA THOMAS P.T.

Provider Business Mailing Address
First Line	:	174 GRAND ST
Second Line	:
City	:	WHITE PLAINS
State	:	NY
Zip	:	10601-4803
Country	:	US
Telephone Number	:	914-328-8077
Fax Number	:	914-328-6083

Provider Business Practice Location Address
First Line	:	3910 WHITE PLAINS RD
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10466-3018
Country	:	US
Telephone Number	:	718-654-0574
Fax Number	:	718-654-0573

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

Provider Enumeration Date	:	06/05/2007
Last Update Date	:	07/08/2007

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