Provider Demographics
NPI:1013255181
Name:THOMAS, JOHN MOLLISON (ATC/L)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:MOLLISON
Last Name:THOMAS
Suffix:
Gender:M
Credentials:ATC/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20759 COUNTY ROAD 101
Mailing Address - Street 2:
Mailing Address - City:ANDALUSIA
Mailing Address - State:AL
Mailing Address - Zip Code:36420-8825
Mailing Address - Country:US
Mailing Address - Phone:334-222-6675
Mailing Address - Fax:334-222-6983
Practice Address - Street 1:20759 COUNTY ROAD 101
Practice Address - Street 2:
Practice Address - City:ANDALUSIA
Practice Address - State:AL
Practice Address - Zip Code:36420-8825
Practice Address - Country:US
Practice Address - Phone:334-222-6675
Practice Address - Fax:334-222-6983
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-24
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1912255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer