Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 9692A | AZ |
NPI | 1003176918 |
---|---|
Provider Name | Allison Donna Ruth Thompson |
First Address | Show Low, AZ 85901-7042 |
Second Address | Show Low, AZ 85901-7888 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2012 |
Last Update Date | 16/01/2013 |