Provider Demographics
NPI:1881587186
Name:THOMAS, BRIAN R (LMT)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:R
Last Name:THOMAS
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:547 MILLER ST
Mailing Address - Street 2:
Mailing Address - City:LUZERNE
Mailing Address - State:PA
Mailing Address - Zip Code:18709-1308
Mailing Address - Country:US
Mailing Address - Phone:570-592-7148
Mailing Address - Fax:
Practice Address - Street 1:104 E OVERBROOK RD
Practice Address - Street 2:
Practice Address - City:SHAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:18708-1143
Practice Address - Country:US
Practice Address - Phone:570-592-7148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-03
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG000598225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist