Healthcare Provider Details

I. General information

NPI: 1003732926
Provider Name (Legal Business Name): ELIZABETH FAITH THOMAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9200 UNIVERSITY BLVD
NORTH CHARLESTON SC
29406-9121
US

IV. Provider business mailing address

9541 LONGMEADOW ST
FENTON MI
48430-8738
US

V. Phone/Fax

Practice location:
  • Phone: 810-224-8585
  • Fax:
Mailing address:
  • Phone: 810-224-8585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberT900000092246
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: