Provider Demographics
NPI:1306352091
Name:THOMAS, GARY (CCSU, CTAT)
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:
Last Name:THOMAS
Suffix:
Gender:M
Credentials:CCSU, CTAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7000 N GREENFIELD DR
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84098-5899
Mailing Address - Country:US
Mailing Address - Phone:310-871-8738
Mailing Address - Fax:
Practice Address - Street 1:1820 SIDEWINDER DR STE 100
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84060-7563
Practice Address - Country:US
Practice Address - Phone:310-871-8738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-18
Last Update Date:2017-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist