Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 40QA01075300 | NJ |
NPI | 1295101509 |
---|---|
Provider Name | Jame William Thomas |
First Address | Bridgeton, NJ 08302-1803 |
Second Address | Millville, NJ 08332-2444 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2015 |
Last Update Date | 20/08/2015 |