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General NPI Number Information
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NPI Number | 1265978183
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Entity Type | Individual
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Provider Name | DAKOTA JAMES THOMPSON MHA, LAT, ATC
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Gender | Male
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Dates
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Enumeration Date | 01/17/2017
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Last Update Date | 10/31/2024
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Provider Practice Location Address
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Address Line | 45 COURTENAY DR
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City | CHARLESTON
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State | SC
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Zip | 29425-8917
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Country | US
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Telephone | 843-792-5757
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Fax |
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Provider Business Mailing Address
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Address Line | 3220 HATCHET BAY DR APT 3412
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City | CHARLESTON
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State | SC
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Zip | 29414-5213
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 1398
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License Number State | SC
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