Provider Demographics
NPI:1811089915
Name:THOMAS, SCOTT (PT)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:THOMAS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 S FRONT ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-4416
Mailing Address - Country:US
Mailing Address - Phone:910-385-7149
Mailing Address - Fax:910-251-8607
Practice Address - Street 1:20 MEDICAL CAMPUS DRIVE
Practice Address - Street 2:SUITE 204 BRUNSWICK MEDICAL CAMPUS
Practice Address - City:SUPPLY
Practice Address - State:NC
Practice Address - Zip Code:28422
Practice Address - Country:US
Practice Address - Phone:910-755-5861
Practice Address - Fax:910-755-5865
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC9237208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7211903Medicaid
NC7211903Medicaid