Provider Demographics
NPI:1619331261
Name:PASS, THOMAS A (MA, ATC)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:A
Last Name:PASS
Suffix:
Gender:M
Credentials:MA, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16375 N ROCKY RD
Mailing Address - Street 2:
Mailing Address - City:MEADOW VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:95722-9535
Mailing Address - Country:US
Mailing Address - Phone:916-203-0558
Mailing Address - Fax:
Practice Address - Street 1:16375 N ROCKY RD
Practice Address - Street 2:
Practice Address - City:MEADOW VISTA
Practice Address - State:CA
Practice Address - Zip Code:95722-9535
Practice Address - Country:US
Practice Address - Phone:916-203-0558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-10
Last Update Date:2016-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer