MEDICARE: EMMA BROOKS THOMAS MS, LAT, ATC

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	AT2128	KY

General Provider Information

NPI Number	:	1336905090
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMMA BROOKS THOMAS MS, LAT, ATC

Provider Business Mailing Address
First Line	:	1 NUNN DR
Second Line	:
City	:	NEWPORT
State	:	KY
Zip	:	41099-0002
Country	:	US
Telephone Number	:	270-438-8436
Fax Number	:	859-572-1565

Provider Business Practice Location Address
First Line	:	1 NUNN DR
Second Line	:
City	:	NEWPORT
State	:	KY
Zip	:	41099-0002
Country	:	US
Telephone Number	:	270-438-8436
Fax Number	:	859-572-1565

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

Provider Enumeration Date	:	02/21/2024
Last Update Date	:	02/21/2024

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