Individual
GORDON THOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
149 RIVERWALK BLVD, SUITE 2, RIDGELAND, SC 29936-8190
(843) 379-1966
(843) 379-1967
Mailing address
149 RIVERWALK BLVD, SUITE 2, RIDGELAND, SC 29936-8190
(843) 379-1966
(843) 379-1967
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
4670
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010793346
TAX ID
—
05
—
TH1469
—
SC
Enumeration date
05/20/2006
Last updated
10/21/2010
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