MEDICARE: MR. JACOB BRUCE THOMAS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer		OH

General Provider Information

NPI Number	:	1235073438
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JACOB BRUCE THOMAS

Provider Business Mailing Address
First Line	:	184 CLIFTON DR
Second Line	:
City	:	YOUNGSTOWN
State	:	OH
Zip	:	44512-1616
Country	:	US
Telephone Number	:	330-720-1249
Fax Number	:

Provider Business Practice Location Address
First Line	:	184 CLIFTON DR
Second Line	:
City	:	YOUNGSTOWN
State	:	OH
Zip	:	44512-1616
Country	:	US
Telephone Number	:	330-720-1249
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/17/2026
Last Update Date	:	04/17/2026

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