Provider Demographics
NPI:1902171879
Name:THOMAS, ELIZABETH JOHN (MASTERS)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:JOHN
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MASTERS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 W TREMONT AVE
Mailing Address - Street 2:SCHOOL PS 306
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10453-5400
Mailing Address - Country:US
Mailing Address - Phone:718-583-5355
Mailing Address - Fax:718-583-5885
Practice Address - Street 1:40 W TREMONT AVE
Practice Address - Street 2:SCHOOL PS 306 RM 157
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453-5400
Practice Address - Country:US
Practice Address - Phone:718-583-5355
Practice Address - Fax:718-583-5885
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-12
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029632-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist