MEDICARE: RAGAN 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	261QP2000X	Physical Therapy Clinic/Center	PTH1927	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1003819608	OTHER	AL	GROUP NPI
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669802104
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAGAN THOMAS

Provider Business Mailing Address
First Line	:	1908 FLINT RD SE
Second Line	:
City	:	DECATUR
State	:	AL
Zip	:	35601-6031
Country	:	US
Telephone Number	:	256-340-9708
Fax Number	:	256-340-9624

Provider Business Practice Location Address
First Line	:	674 OLLIE AVE
Second Line	:
City	:	CLANTON
State	:	AL
Zip	:	35045-2246
Country	:	US
Telephone Number	:	205-280-1100
Fax Number	:	205-280-1575

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

Provider Enumeration Date	:	11/20/2013
Last Update Date	:	11/20/2013

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Directions to “ RAGAN THOMAS ” Practice Location

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