Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | ||
N | 225100000X | Physical Therapist | 9949-024 | WI |
Y | 2251G0304X | Physical Therapist - Geriatrics | 070013159 | IL |
NPI | 1306813670 |
---|---|
Provider Name | Mrs. Brookly Jean Becke Thompson |
First Address | Paducah, KY 42001-6187 |
Second Address | Paducah, KY 42001-6187 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/03/2006 |
Last Update Date | 19/02/2021 |