Provider Demographics
NPI:1245615491
Name:HUMPHRIES, THOMAS II
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:
Last Name:HUMPHRIES
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9912 ALF CT
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-7342
Mailing Address - Country:US
Mailing Address - Phone:804-938-5517
Mailing Address - Fax:
Practice Address - Street 1:10327 WEST BROAD ST.
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:20360-7342
Practice Address - Country:US
Practice Address - Phone:804-754-3600
Practice Address - Fax:804-754-1411
Is Sole Proprietor?:No
Enumeration Date:2015-07-29
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2101002041237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist