Basic Information
| Provider Information | |||||||||
| NPI: | 1396183927 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LOPER | ||||||||
| FirstName: | THOMAS | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 50 BAY ST | ||||||||
| Address2: | |||||||||
| City: | CLANTON | ||||||||
| State: | AL | ||||||||
| PostalCode: | 350453000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2052593991 | ||||||||
| FaxNumber: | 2058768663 | ||||||||
| Practice Location | |||||||||
| Address1: | 6542 GOODMAN RD STE 101 | ||||||||
| Address2: | |||||||||
| City: | OLIVE BRANCH | ||||||||
| State: | MS | ||||||||
| PostalCode: | 386545559 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2052593991 | ||||||||
| FaxNumber: | 2058768663 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2013 | ||||||||
| LastUpdateDate: | 01/22/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.