Provider Demographics
NPI:1477331445
Name:THOMAS, NICOLAS JORDAN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:NICOLAS
Middle Name:JORDAN
Last Name:THOMAS
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 SHUFORD RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:NC
Mailing Address - Zip Code:28722-7406
Mailing Address - Country:US
Mailing Address - Phone:828-894-0277
Mailing Address - Fax:828-894-0278
Practice Address - Street 1:6400 HIGHWAY 9
Practice Address - Street 2:STE D
Practice Address - City:INMAN
Practice Address - State:SC
Practice Address - Zip Code:29349-6927
Practice Address - Country:US
Practice Address - Phone:864-699-9441
Practice Address - Fax:864-699-9279
Is Sole Proprietor?:No
Enumeration Date:2023-09-20
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11975225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist