Provider Demographics
NPI:1871566927
Name:THOMAS, JOSE P (PT)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:P
Last Name:THOMAS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 78
Mailing Address - Street 2:
Mailing Address - City:EASTWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:40018-0078
Mailing Address - Country:US
Mailing Address - Phone:502-995-8844
Mailing Address - Fax:502-995-8842
Practice Address - Street 1:10116 DIXIE HWY
Practice Address - Street 2:PRIME TIME PHYSICAL THERAPY PLLC
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40272-3948
Practice Address - Country:US
Practice Address - Phone:502-995-8844
Practice Address - Fax:502-995-8842
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-09
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4438225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY8700191300Medicaid
KY8700191300Medicaid