Provider Demographics
NPI:1194158360
Name:PRETLOW, THOMAS JUSTIN (PT)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:JUSTIN
Last Name:PRETLOW
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 1:5690 THREE NOTCH D RD
Mailing Address - Street 2:# 107
Mailing Address - City:CROZET
Mailing Address - State:VA
Mailing Address - Zip Code:22932-3172
Mailing Address - Country:US
Mailing Address - Phone:434-823-7628
Mailing Address - Fax:434-823-7681
Practice Address - Street 1:5690 THREE NOTCH D RD
Practice Address - Street 2:# 107
Practice Address - City:CROZET
Practice Address - State:VA
Practice Address - Zip Code:22932-3172
Practice Address - Country:US
Practice Address - Phone:434-823-7628
Practice Address - Fax:434-823-7681
Is Sole Proprietor?:No
Enumeration Date:2013-08-12
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305208143225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist