Provider Demographics
NPI:1306604442
Name:THOMAS, LAKAY (PTA)
Entity type:Individual
Prefix:
First Name:LAKAY
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28100 TORCH PKWY STE 600
Mailing Address - Street 2:
Mailing Address - City:WARRENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60555-4030
Mailing Address - Country:US
Mailing Address - Phone:630-413-5800
Mailing Address - Fax:
Practice Address - Street 1:28100 TORCH PKWY STE 600
Practice Address - Street 2:
Practice Address - City:WARRENVILLE
Practice Address - State:IL
Practice Address - Zip Code:60555-4030
Practice Address - Country:US
Practice Address - Phone:630-413-5800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-12
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160.005809225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty