Individual
AUTUMN THOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LAT, ATC
Contact information
Practice address
139 BAMBOO AVE SE, PALM BAY, FL 32909-3764
(321) 537-1857
Mailing address
139 BAMBOO AVE SE, PALM BAY, FL 32909-3764
(321) 537-1857
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AL4840
FL
390200000X
Student in an Organized Health Care Education/Training Program
T520-017-93-802-0
FL
Other
Enumeration date
07/07/2014
Last updated
11/25/2019
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