Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | A00746 | KY |
NPI | 1003079948 |
---|---|
Provider Name | Mrs. Moris Ann Thompson |
First Address | Mayfield, KY 42066-1799 |
Second Address | Mayfield, KY 42066-1799 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2008 |
Last Update Date | 09/07/2008 |