Provider Demographics
NPI:1386745602
Name:AMUNDSON, THOMAS L (PT)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:L
Last Name:AMUNDSON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2050 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RED BLUFF
Mailing Address - State:CA
Mailing Address - Zip Code:96080-2373
Mailing Address - Country:US
Mailing Address - Phone:530-528-9112
Mailing Address - Fax:530-528-9398
Practice Address - Street 1:355 MAIN ST
Practice Address - Street 2:
Practice Address - City:RED BLUFF
Practice Address - State:CA
Practice Address - Zip Code:96080-3413
Practice Address - Country:US
Practice Address - Phone:530-528-9112
Practice Address - Fax:530-528-9398
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2008-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT8266225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ66069ZOtherBLUE SHIELD GROUP NUMBER
CAP00305915OtherRAILROAD MEDICARE
CAZZZ66069ZOtherBLUE SHIELD GROUP NUMBER