Provider Demographics
NPI:1285989871
Name:THOMAS, BEVERLY C (HS-BCP)
Entity type:Individual
Prefix:MS
First Name:BEVERLY
Middle Name:C
Last Name:THOMAS
Suffix:
Gender:F
Credentials:HS-BCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3123 ROSS AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28208-7131
Mailing Address - Country:US
Mailing Address - Phone:704-777-0602
Mailing Address - Fax:
Practice Address - Street 1:3123 ROSS AVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28208-7131
Practice Address - Country:US
Practice Address - Phone:704-777-0602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-19
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner