Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 0486 | SD |
NPI | 1114179751 |
---|---|
Provider Name | Mrs. Lorelei Jo Thompson |
First Address | Sioux Falls, SD 57103-7245 |
Second Address | Sioux Falls, SD 57103-7245 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/10/2008 |
Last Update Date | 14/10/2008 |