Individual
TABITHA E THODE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3447 GAVESON CT, PORT ORANGE, FL 32129-3122
(386) 366-2477
Mailing address
5235 CHRISTIANCY AVE, PORT ORANGE, FL 32127-5571
Taxonomy
Speciality
Code
Description
License number
State
207PS0010X
Sports Medicine (Emergency Medicine) Physician
AL6607
FL
2255A2300X
Athletic Trainer
Primary
2902
AL
2255A2300X
Athletic Trainer
AL6607
FL
Other
Enumeration date
07/28/2019
Last updated
07/17/2024
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