Provider Demographics
NPI:1861414898
Name:REID, THOMAS L JR (LPT)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:L
Last Name:REID
Suffix:JR
Gender:M
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 CENTRAL DR
Mailing Address - Street 2:
Mailing Address - City:AZLE
Mailing Address - State:TX
Mailing Address - Zip Code:76020-3140
Mailing Address - Country:US
Mailing Address - Phone:817-444-8827
Mailing Address - Fax:817-444-8847
Practice Address - Street 1:408 CENTRAL DR
Practice Address - Street 2:
Practice Address - City:AZLE
Practice Address - State:TX
Practice Address - Zip Code:76020-3140
Practice Address - Country:US
Practice Address - Phone:817-444-8827
Practice Address - Fax:817-444-8847
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1016517225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX650423Medicare ID - Type UnspecifiedPHYSICAL THERAPIST