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General NPI Number Information
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NPI Number | 1598950206
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Entity Type | Individual
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Provider Name | THOMAS JOHN MAYTUM JR. PTA
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Gender | Male
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Dates
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Enumeration Date | 09/06/2007
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Last Update Date | 09/06/2007
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Provider Practice Location Address
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Address Line | 1225 BROADRICK DR
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City | DALTON
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State | GA
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Zip | 30720-2504
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Country | US
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Telephone | 706-272-6199
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Fax | 706-272-6291
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Provider Business Mailing Address
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Address Line | 1225 BROADRICK DR
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City | DALTON
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State | GA
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Zip | 30720-2504
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Country | US
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Telephone | 706-272-6199
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Fax | 706-272-6291
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA001065
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA15969
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License Number State | FL
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