Provider Demographics
NPI:1023137981
Name:BEDDOW, THOMAS WARREN (ATC)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:WARREN
Last Name:BEDDOW
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2216 W SAINT JOSEPH ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-4037
Mailing Address - Country:US
Mailing Address - Phone:302-995-9070
Mailing Address - Fax:
Practice Address - Street 1:1500 CEDAR ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19805-4294
Practice Address - Country:US
Practice Address - Phone:302-656-3369
Practice Address - Fax:302-656-0163
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ3-00000632255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE22OtherATHLETIC TRAINER