Tabitha E Thode

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

2902 Issued in AL

Practice address

3447 Gaveson CT
Port Orange, FL 32129-3122

Phone

(386) 366-2477

NPI assigned

Jul 28, 2019

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1564272000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721174400000",
    "number": "1265086250",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5235 CHRISTIANCY AVE",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321275571"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3447 GAVESON CT",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321293122",
            "telephone_number": "386-366-2477"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THODE",
        "first_name": "TABITHA",
        "middle_name": "E",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-07-28",
        "last_updated": "2024-07-17",
        "certification_date": "2024-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207PS0010X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Sports Medicine",
            "state": "FL",
            "license": "AL6607",
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "FL",
            "license": "AL6607",
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "AL",
            "license": "2902",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kerry Diane Thek, M.D.
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• Brandy Thompson, MA, RMHCI
• Margaret M. Thompson, A.R.N.P., M.S.N

• Athletic Trainer in Port Orange, FL
• Providers in Port Orange, FL by specialty
• Athletic Trainer in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.