Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | CP008706T | VA |
N | 2251G0304X | Physical Therapist - Geriatrics | 13916 | TN |
NPI | 1083371694 |
---|---|
Provider Name | Hunter K Thompson |
First Address | Brentwood, TN 37027-5178 |
Second Address | Springfield, VA 22150-1823 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2021 |
Last Update Date | 29/11/2021 |