Provider Demographics
NPI:1124741913
Name:THOMAS, TESS MIKAYLA (DPT)
Entity type:Individual
Prefix:MRS
First Name:TESS
Middle Name:MIKAYLA
Last Name:THOMAS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:TESS
Other - Middle Name:MIKAYLA
Other - Last Name:HUMBERSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:74 ERIN DR
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508-1371
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:258 MUDD PIKE RD
Practice Address - Street 2:
Practice Address - City:MARKLEYSBURG
Practice Address - State:PA
Practice Address - Zip Code:15459-1110
Practice Address - Country:US
Practice Address - Phone:724-970-7210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-26
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV004558225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist