MEDICARE: NATHANIEL LEE THOMPSON PT, DPT, MBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	18602	NC

General Provider Information

NPI Number	:	1144786633
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATHANIEL LEE THOMPSON PT, DPT, MBA

Provider Business Mailing Address
First Line	:	112 DERBY LN
Second Line	:
City	:	LILLINGTON
State	:	NC
Zip	:	27546-6735
Country	:	US
Telephone Number	:	336-552-6567
Fax Number	:

Provider Business Practice Location Address
First Line	:	2209 ASSOCIATE DR
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27603-8123
Country	:	US
Telephone Number	:	919-322-0049
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/20/2019
Last Update Date	:	07/20/2025

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