Provider Demographics
NPI:1730295122
Name:THOMAS, DESHENA D (ATC, MS)
Entity Type:Individual
Prefix:MS
First Name:DESHENA
Middle Name:D
Last Name:THOMAS
Suffix:
Gender:F
Credentials:ATC, MS
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Mailing Address - Street 1:391 SADIE LOOP
Mailing Address - Street 2:
Mailing Address - City:LUCEDALE
Mailing Address - State:MS
Mailing Address - Zip Code:39452-1962
Mailing Address - Country:US
Mailing Address - Phone:251-463-5052
Mailing Address - Fax:251-847-3988
Practice Address - Street 1:17527 JORDAN STREET
Practice Address - Street 2:
Practice Address - City:CHATOM
Practice Address - State:AL
Practice Address - Zip Code:36518
Practice Address - Country:US
Practice Address - Phone:251-847-3955
Practice Address - Fax:251-847-3988
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL7832255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer