Provider Demographics
NPI:1871900126
Name:KINNEY, THOMAS
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:KINNEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7660 PANGEA LN
Mailing Address - Street 2:APT 206
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-5854
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7660 PANGEA LN
Practice Address - Street 2:APT 206
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27616-5854
Practice Address - Country:US
Practice Address - Phone:602-679-0705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-18
Last Update Date:2014-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer