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NPI Code Detail

MEDICARE: MRS. STEPHANIE SUSANNE THOMAS PTA

MEDICARE: MRS. STEPHANIE SUSANNE 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
1225200000XPhysical Therapy Assistant2998TN

General Provider Information

NPI Number : 1699854182
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. STEPHANIE SUSANNE THOMAS PTA
Provider Business Mailing Address
First Line : 2900 JOHN ANDREW LN
Second Line :
City : KNOXVILLE
State : TN
Zip : 37931-3351
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1018 HIGHWAY 321 N
Second Line :
City : LENOIR CITY
State : TN
Zip : 37771-6683
Country : US
Telephone Number : 865-986-5644
Fax Number : 865-986-9109
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/03/2006
Last Update Date : 07/08/2007

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