Provider Demographics
NPI:1871083873
Name:THOMAS, KIMBERLY ELLEN (PTA)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ELLEN
Last Name:THOMAS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8527 N BRIARPATCH AVE
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL RIVER
Mailing Address - State:FL
Mailing Address - Zip Code:34428-8610
Mailing Address - Country:US
Mailing Address - Phone:352-201-1851
Mailing Address - Fax:
Practice Address - Street 1:8733 W YULEE DR
Practice Address - Street 2:
Practice Address - City:HOMOSASSA
Practice Address - State:FL
Practice Address - Zip Code:34448-4222
Practice Address - Country:US
Practice Address - Phone:352-464-8627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-15
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA26471225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant