Provider Demographics
NPI:1568845121
Name:AUTEN, THOMAS ADAM (PT, DPT)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:ADAM
Last Name:AUTEN
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 1:1718 BEE BALM RD
Mailing Address - Street 2:
Mailing Address - City:JOHNS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29455-7759
Mailing Address - Country:US
Mailing Address - Phone:803-984-5795
Mailing Address - Fax:
Practice Address - Street 1:1718 BEE BALM RD
Practice Address - Street 2:
Practice Address - City:JOHNS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29455-7759
Practice Address - Country:US
Practice Address - Phone:803-984-5795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-01
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7099225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist