Provider Demographics
NPI:1730278078
Name:THOMAS, JOSEPH M (PT)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:M
Last Name:THOMAS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2416 HIGHWAY 45 N
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39705-1320
Mailing Address - Country:US
Mailing Address - Phone:601-355-9624
Mailing Address - Fax:601-353-6151
Practice Address - Street 1:276 NISSAN PKWY
Practice Address - Street 2:SUITE 400, BLDG F
Practice Address - City:CANTON
Practice Address - State:MS
Practice Address - Zip Code:39046-7006
Practice Address - Country:US
Practice Address - Phone:601-859-3776
Practice Address - Fax:601-859-3778
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT0271225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS650000283Medicare ID - Type Unspecified