MEDICARE: THOMAS ANDREW PHILLIPS 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	2212	NC

General Provider Information

NPI Number	:	1649169350
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS ANDREW PHILLIPS LAT, ATC

Provider Business Mailing Address
First Line	:	1420 ATHENS DR
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27606-2427
Country	:	US
Telephone Number	:	919-233-4050
Fax Number	:	919-233-4054

Provider Business Practice Location Address
First Line	:	1420 ATHENS DR
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27606-2427
Country	:	US
Telephone Number	:	919-233-4050
Fax Number	:	919-233-4054

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

Provider Enumeration Date	:	06/30/2025
Last Update Date	:	06/30/2025

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