Provider Demographics
NPI:1689366577
Name:THOMAS, JESTINE SHELBY NICOLE
Entity Type:Individual
Prefix:
First Name:JESTINE
Middle Name:SHELBY NICOLE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5511 BELLE POND DR
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23234-3400
Mailing Address - Country:US
Mailing Address - Phone:804-475-6800
Mailing Address - Fax:
Practice Address - Street 1:5511 BELLE POND DR
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23234-3400
Practice Address - Country:US
Practice Address - Phone:804-475-6800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer