Provider Demographics
NPI:1194174573
Name:THOMAS, EMILY
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4236 NW 12TH LOOP
Mailing Address - Street 2:
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607-7965
Mailing Address - Country:US
Mailing Address - Phone:360-573-7411
Mailing Address - Fax:206-706-7890
Practice Address - Street 1:9725 3RD AVE NE
Practice Address - Street 2:SUITE 100
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-2060
Practice Address - Country:US
Practice Address - Phone:206-706-7500
Practice Address - Fax:206-706-7890
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-07
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60636698225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist