Individual
THOMAS JAMES FREDERICK JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
112 REPUBLIC AVE STE E, LAFAYETTE, LA 70508-6863
(337) 988-7777
(337) 988-7720
Mailing address
2010 FEATHER ROCK CIR, MAURICE, LA 70555-3365
(337) 277-5446
(337) 988-7720
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
09059
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
09059
LA PHYSICAL THERAPY BOARD LICENSE NUMBER
LA
Enumeration date
08/11/2015
Last updated
08/11/2015
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