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NPI Code Detail

MEDICARE: DR. JEREMIAH DANIEL THOMPSON PT DPT

MEDICARE:  DR. JEREMIAH DANIEL THOMPSON  PT DPT
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
12251G0304XGeriatric Physical Therapist2305210529VA
22251G0304XGeriatric Physical TherapistPT017037OH

General Provider Information

NPI Number : 1700300878
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JEREMIAH DANIEL THOMPSON PT DPT
Provider Business Mailing Address
First Line : 3141 WARRINGTON RD
Second Line :
City : CLEVELAND
State : OH
Zip : 44120-2428
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 10603 DETROIT AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44102-1647
Country : US
Telephone Number : 216-226-0282
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/01/2017
Last Update Date : 08/01/2017

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