Individual
JUSTIN LYLE THOMAS
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
1801 WILSON AVE, BRISTOL, PA 19007-4220
(215) 550-1017
Mailing address
3450 DIVISION ST, REAR, PHILADELPHIA, PA 19129-1429
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
LA
Other
Enumeration date
04/10/2006
Last updated
07/08/2007
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