Basic Information
| Provider Information | |||||||||
| NPI: | 1407956642 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THOMAS K. WAUGH & ASSOCIATES, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9398 VISCOUNT BLVD | ||||||||
| Address2: | SUITE 3C | ||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799258056 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9155938555 | ||||||||
| FaxNumber: | 9155932422 | ||||||||
| Practice Location | |||||||||
| Address1: | 9398 VISCOUNT BLVD | ||||||||
| Address2: | SUITE 3C | ||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799258056 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9155938555 | ||||||||
| FaxNumber: | 9155932422 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/25/2006 | ||||||||
| LastUpdateDate: | 11/09/2007 | ||||||||
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| AuthorizedOfficialLastName: | WAUGH | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9155938555 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | P.T. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.