MEDICARE: MS. ELIZABETH LYNN THOMSON PT

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	225100000X	Physical Therapist	654	NM

General Provider Information

NPI Number	:	1992873939
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELIZABETH LYNN THOMSON PT

Provider Business Mailing Address
First Line	:	1216 WESTERFELD DR NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87112-5263
Country	:	US
Telephone Number	:	505-239-1781
Fax Number	:

Provider Business Practice Location Address
First Line	:	1216 WESTERFELD DR NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87112-5263
Country	:	US
Telephone Number	:	505-239-1781
Fax Number	:

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

Provider Enumeration Date	:	11/30/2006
Last Update Date	:	07/08/2007

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