Basic Information
Provider Information
NPI: 1356419311
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: THOMAS
FirstName: JODI
MiddleName: L.
NamePrefix:  
NameSuffix:  
Credential: DPT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4601 HARTFORD ST
Address2:  
City: ABILENE
State: TX
PostalCode: 796054603
CountryCode: US
TelephoneNumber: 3257933400
FaxNumber: 3257933587
Practice Location
Address1: 4601 HARTFORD ST
Address2:  
City: ABILENE
State: TX
PostalCode: 796054603
CountryCode: US
TelephoneNumber: 3257933449
FaxNumber: 3257933549
Other Information
ProviderEnumerationDate: 11/30/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X1162382TXY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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