Active NPI
Thomas Spock III, ATC
- Athletic Trainer
- Saint Leo, FL
National Provider Identifier
1710546361
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 4541
- Practice address
- 33701 State Road 52
Saint Leo, FL 33574 - Phone
- (352) 588-8112
- NPI assigned
- Jun 7, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 4541 | FL | Primary |
Addresses
Primary practice location
33701 State Road 52
Saint Leo, FL 33574
Mailing address
PO Box 6665
Saint Leo, FL 33574-6665
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4541 | FL | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1559865600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1559865600000",
"number": "1710546361",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 6665",
"city": "SAINT LEO",
"state": "FL",
"postal_code": "335746665"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "33701 STATE ROAD 52",
"city": "SAINT LEO",
"state": "FL",
"postal_code": "33574",
"telephone_number": "352-588-8112"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SPOCK",
"first_name": "THOMAS",
"name_prefix": "Mr.",
"name_suffix": "III",
"credential": "ATC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-06-07",
"last_updated": "2019-06-07",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "FL",
"license": "4541",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Leo, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.