Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 16661 | MA |
NPI | 1124209960 |
---|---|
Provider Name | Mrs. Jamie Marie Thompson |
First Address | Lowell, MA 01852-4931 |
Second Address | Lowell, MA 01852-4931 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2007 |
Last Update Date | 20/11/2007 |