Provider Demographics
NPI:1992715445
Name:THOMAS, ANNE MCNEELY (PT)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:MCNEELY
Last Name:THOMAS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:642 S ALASKA ST
Mailing Address - Street 2:STE 209
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645
Mailing Address - Country:US
Mailing Address - Phone:907-746-0722
Mailing Address - Fax:907-746-0732
Practice Address - Street 1:642 S ALASKA ST
Practice Address - Street 2:STE 209
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645
Practice Address - Country:US
Practice Address - Phone:907-746-0722
Practice Address - Fax:907-746-0732
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1312225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKPT1312Medicaid
AKK153329Medicare ID - Type Unspecified