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NPI Code Detail

MEDICARE: JESSICA M THOMAS MS, ATC

MEDICARE: JESSICA M THOMAS MS, 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
12255A2300XAthletic Trainer0860AZ

General Provider Information

NPI Number : 1538306873
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA M THOMAS MS, ATC
Provider Business Mailing Address
First Line : 8726 E BERRIDGE LN
Second Line :
City : SCOTTSDALE
State : AZ
Zip : 85250-5808
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3300 W CAMELBACK RD
Second Line :
City : PHOENIX
State : AZ
Zip : 85017-3030
Country : US
Telephone Number : 602-639-6066
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/08/2009
Last Update Date : 01/08/2009

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