Provider Demographics
NPI:1720251648
Name:DEWEY, THOMAS (LMT)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:DEWEY
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 492
Mailing Address - Street 2:
Mailing Address - City:ELLENBORO
Mailing Address - State:WV
Mailing Address - Zip Code:26346-0492
Mailing Address - Country:US
Mailing Address - Phone:757-348-2912
Mailing Address - Fax:
Practice Address - Street 1:4315 EMERSON AVE
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26104-1217
Practice Address - Country:US
Practice Address - Phone:304-428-8300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-11
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2007-2336225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist