Healthcare Provider Details

I. General information

NPI: 1033029681
Provider Name (Legal Business Name): TREVOR DANIEL THOMAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 REFUGEE RD STE 296
PICKERINGTON OH
43147-9653
US

IV. Provider business mailing address

1010 REFUGEE RD STE 296
PICKERINGTON OH
43147-9653
US

V. Phone/Fax

Practice location:
  • Phone: 614-788-4300
  • Fax:
Mailing address:
  • Phone: 614-788-4300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number10351
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: