Provider Demographics
NPI:1073129961
Name:THOMASON, JAMES F (LMT, MMP)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:F
Last Name:THOMASON
Suffix:
Gender:M
Credentials:LMT, MMP
Other - Prefix:
Other - First Name:JIM
Other - Middle Name:
Other - Last Name:THOMASON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT, MMP
Mailing Address - Street 1:5142 8TH AVE N
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-6604
Mailing Address - Country:US
Mailing Address - Phone:404-441-7648
Mailing Address - Fax:
Practice Address - Street 1:1211 1ST AVE N # 211
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33705-1567
Practice Address - Country:US
Practice Address - Phone:727-537-0204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-16
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA78961225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist