Provider Demographics
NPI:1528355997
Name:STATON, THOMAS DENNIS (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:DENNIS
Last Name:STATON
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5130 SAN FRANCISCO RD NE STE B
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-4618
Mailing Address - Country:US
Mailing Address - Phone:505-823-2411
Mailing Address - Fax:
Practice Address - Street 1:5130 SAN FRANCISCO RD NE STE B
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-4618
Practice Address - Country:US
Practice Address - Phone:505-823-2411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-06
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPT4114225100000X
NM4114225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist