Provider Demographics
NPI:1336945500
Name:THOMAS, DEMARCO ANTONIO (DPT)
Entity type:Individual
Prefix:DR
First Name:DEMARCO
Middle Name:ANTONIO
Last Name:THOMAS
Suffix:
Gender:
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2659 IMPERIAL GROVE LN
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77385-8325
Mailing Address - Country:US
Mailing Address - Phone:281-505-5862
Mailing Address - Fax:
Practice Address - Street 1:9166 FM 2920 RD STE 375
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-8996
Practice Address - Country:US
Practice Address - Phone:346-336-7501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-19
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1405644225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist