Provider Demographics
NPI:1235665779
Name:THOMAS, SEAN (ATC)
Entity Type:Individual
Prefix:MR
First Name:SEAN
Middle Name:
Last Name:THOMAS
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 FAYETTEVILLE ST
Mailing Address - Street 2:PO BOX 19705
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-3129
Mailing Address - Country:US
Mailing Address - Phone:919-530-6215
Mailing Address - Fax:919-530-7799
Practice Address - Street 1:1801 FAYETTEVILLE ST
Practice Address - Street 2:BOX 19705
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-3129
Practice Address - Country:US
Practice Address - Phone:919-530-6215
Practice Address - Fax:919-530-7799
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-03
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC04502255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer