Provider Demographics
NPI:1104276138
Name:THOMAS, JAMES KEVIN (ATC)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:KEVIN
Last Name:THOMAS
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 GOOSE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:GOOSE CREEK
Mailing Address - State:SC
Mailing Address - Zip Code:29445-3224
Mailing Address - Country:US
Mailing Address - Phone:843-530-0400
Mailing Address - Fax:
Practice Address - Street 1:109 GOOSE CREEK DR
Practice Address - Street 2:
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445-3224
Practice Address - Country:US
Practice Address - Phone:843-530-0400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-21
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC16582255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer