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General NPI Number Information
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NPI Number | 1750759551
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Entity Type | Individual
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Provider Name | THOMAS DEWEY ATC
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Gender | Male
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Dates
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Enumeration Date | 09/10/2015
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Last Update Date | 03/17/2021
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Provider Practice Location Address
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Address Line | 472 POLARIS ST
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City | VIRGINIA BEACH
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State | VA
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Zip | 23461-1935
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Country | US
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Telephone | 757-862-0081
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Fax |
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Provider Business Mailing Address
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Address Line | 2249 HISTORIC DECATUR RD UNIT 81
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City | SAN DIEGO
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State | CA
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Zip | 92106-6102
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Country | US
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Telephone | 757-575-0064
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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 | 010702088
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License Number State | VA
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