Provider Demographics
NPI:1982944500
Name:MITCHUM, THOMAS ANDREW (DPT)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:ANDREW
Last Name:MITCHUM
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 GROVE RD
Mailing Address - Street 2:SUITE 2-A
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-4660
Mailing Address - Country:US
Mailing Address - Phone:864-233-5128
Mailing Address - Fax:864-271-2599
Practice Address - Street 1:1011 GROVE RD
Practice Address - Street 2:SUITE 2-A
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4660
Practice Address - Country:US
Practice Address - Phone:864-233-5128
Practice Address - Fax:864-271-2599
Is Sole Proprietor?:No
Enumeration Date:2013-02-19
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6955225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist