Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 2306602229 | VA |
NPI | 1013347095 |
---|---|
Provider Name | Sean Thompson |
First Address | Upper Marlboro, MD 20774-1844 |
Second Address | Upper Marlboro, MD 20774-1844 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/11/2013 |
Last Update Date | 12/11/2013 |