Provider Demographics
NPI:1548004625
Name:THOMAS, JONATHAN (LPTA)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:THOMAS
Suffix:
Gender:M
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 ASHTON CT
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-3334
Mailing Address - Country:US
Mailing Address - Phone:251-751-7653
Mailing Address - Fax:
Practice Address - Street 1:1220 AZALEA RD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36693-2859
Practice Address - Country:US
Practice Address - Phone:251-260-0442
Practice Address - Fax:888-539-6550
Is Sole Proprietor?:No
Enumeration Date:2024-06-24
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTA3771225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant