Individual
MS. MADONNA RENEE THOMAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
7725 HIGHWAY 62 STE 300, CHARLESTOWN, IN 47111-9676
(812) 256-2147
(812) 256-2252
Mailing address
2700 STANLEY GAULT PKWY STE 129, LOUISVILLE, KY 40223-5176
(502) 253-4919
(502) 489-5751
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
001334
KY
225100000X
Physical Therapist
Primary
05002013A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000230208
ANTHEM PROVIDER #
KY
05
—
200432370
—
IN
01
—
P00069385
MEDICARE RAILROAD
IN
Enumeration date
03/05/2007
Last updated
12/03/2020
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