Individual provider Active NPI

Kenneth Fred Thomas Jr., DPT

  • Physical Therapist
  • Sunbury, PA
National Provider Identifier
1033495163
Registry record updated Dec 6, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT021720 Issued in PA
Practice address
1072 Market St Lowr Level
Sunbury, PA 17801-2458
Phone
(570) 217-2144
Fax
(570) 415-0124
NPI assigned
Nov 3, 2011
Last updated
Dec 6, 2019By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 6, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X DAPT002916 PA
Physical Therapist 225100000X PT021720 PA Primary

Addresses

Primary practice location

1072 Market St Lowr Level
Sunbury, PA 17801-2458

Mailing address

7 Dock Hill Rd
Middleburg, PA 17842-8910
Phone (570) 837-2123

Other identifiers 2

IdentifierTypeStateIssuer
1026544360029MedicaidPA
768441OtherPAMEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120123000040 PA Practitioner - Physical Therapist in Private Practice 6507033149 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Family Practice Center PCGroup PAC ID 0244124212, 351 clinicians

Practice addresses (Care Compare)

1 Dock Hill Rd
Middleburg, PA 17842-8910
Phone (570) 837-5889

100 1St St
Millersburg, PA 17061-1501
Phone (717) 692-4834

1072 Market St
Sunbury, PA 17801-2458
Phone (570) 286-8521

2350 E 3Rd St
Williamsport, PA 17701-4088
Phone (570) 743-1703

4897 State Route 209
Elizabethville, PA 17023-8455
Phone (717) 362-8810

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DAPT002916PAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Family Practice Center, PC CurrentSince Mar 1, 2019 Accepting new patients
Family Practice Center, PC Multi-Specialty CurrentSince Mar 1, 2019 Accepting new patients

Locations

7 Dock Hill Rd
Middleburg, PA 17842
Phone (570) 837-2123

75 Evelyn Dr
Millersburg, PA 17061
Phone (717) 692-4708

2 College Ave
Mountville, PA 17554
Phone (717) 285-3144

1072 Market St
Lowr
Sunbury, PA 17801
Phone (570) 217-2144

Interoperability endpoints

  • Direct secure messaging: kthomas@direct.cprspt.com

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1320278400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1575590400000",
    "number": "1033495163",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7 DOCK HILL RD",
            "city": "MIDDLEBURG",
            "state": "PA",
            "postal_code": "178428910",
            "telephone_number": "570-837-2123",
            "fax_number": "570-837-2123"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1072 MARKET ST LOWR LEVEL",
            "city": "SUNBURY",
            "state": "PA",
            "postal_code": "178012458",
            "telephone_number": "570-217-2144",
            "fax_number": "570-415-0124"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THOMAS",
        "first_name": "KENNETH",
        "middle_name": "FRED",
        "name_suffix": "Jr.",
        "credential": "DPT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-11-03",
        "last_updated": "2019-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "PA",
            "license": "DAPT002916",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "PA",
            "license": "PT021720",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1026544360029",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "768441",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sunbury, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.