Provider Demographics
NPI:1649169350
Name:PHILLIPS, THOMAS ANDREW (LAT, ATC)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:ANDREW
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 ATHENS DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27606-2427
Mailing Address - Country:US
Mailing Address - Phone:919-233-4050
Mailing Address - Fax:919-233-4054
Practice Address - Street 1:1420 ATHENS DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27606-2427
Practice Address - Country:US
Practice Address - Phone:919-233-4050
Practice Address - Fax:919-233-4054
Is Sole Proprietor?:No
Enumeration Date:2025-06-30
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22122255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer