Provider Demographics
NPI:1124631056
Name:THOMAS, DYNESHA
Entity type:Individual
Prefix:
First Name:DYNESHA
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2011 2ND LOOP RD STE C
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-6187
Mailing Address - Country:US
Mailing Address - Phone:843-702-0156
Mailing Address - Fax:843-720-0149
Practice Address - Street 1:525 3RD LOOP RD APT H
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29505-4706
Practice Address - Country:US
Practice Address - Phone:843-734-7199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-29
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No335E00000XSuppliersProsthetic/Orthotic Supplier