Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 001892 | KY |
N | 2251P0200X | Physical Therapist - Pediatrics | 001892 | KY |
NPI | 1083176465 |
---|---|
Provider Name | Amy Canter Thompson |
First Address | Lexington, KY 40502-1668 |
Second Address | Lexington, KY 40502-1668 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2019 |
Last Update Date | 03/04/2019 |