Provider Demographics
NPI:1538346978
Name:THOMS, TRICIA T (DPT, ATC)
Entity type:Individual
Prefix:DR
First Name:TRICIA
Middle Name:T
Last Name:THOMS
Suffix:
Gender:F
Credentials:DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 N PROSPECT AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-3041
Mailing Address - Country:US
Mailing Address - Phone:310-376-9222
Mailing Address - Fax:310-376-9888
Practice Address - Street 1:520 N PROSPECT AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-3041
Practice Address - Country:US
Practice Address - Phone:310-376-9222
Practice Address - Fax:310-376-9888
Is Sole Proprietor?:No
Enumeration Date:2008-01-29
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34316225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB227266Medicare PIN
CAW17215BMedicare PIN