Provider Demographics
NPI:1871700344
Name:THOMAS, ALAN JOHN (MASSAGE THERAPIST)
Entity type:Individual
Prefix:MR
First Name:ALAN
Middle Name:JOHN
Last Name:THOMAS
Suffix:
Gender:M
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5248 LAKE VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34235-2044
Mailing Address - Country:US
Mailing Address - Phone:941-379-9168
Mailing Address - Fax:
Practice Address - Street 1:7274 55TH AVE E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34203-8002
Practice Address - Country:US
Practice Address - Phone:941-752-4451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 28706225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist