Provider Demographics
NPI:1003326091
Name:CHAO, TOMAS F (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:TOMAS
Middle Name:F
Last Name:CHAO
Suffix:
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 SUMMIT CROSSING PL STE 208
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-2142
Mailing Address - Country:US
Mailing Address - Phone:704-671-5730
Mailing Address - Fax:704-671-5750
Practice Address - Street 1:1744 LANE RD
Practice Address - Street 2:
Practice Address - City:MT HOLLY
Practice Address - State:NC
Practice Address - Zip Code:28120-9037
Practice Address - Country:US
Practice Address - Phone:704-836-9613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-04
Last Update Date:2017-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLAT-20332255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer