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Individual
GORDON THOMAS
Active
Individual
GORDON THOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T.
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
4670
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010793346
TAX ID
—
05
—
TH1469
—
SC
Enumeration date
05/20/2006
Last updated
10/21/2010
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