Healthcare Provider Details

I. General information

NPI: 1730602277
Provider Name (Legal Business Name): MARY LILLIAN THOMPSON DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7601 IMPERIAL HWY # HB223
DOWNEY CA
90242-3456
US

IV. Provider business mailing address

7601 IMPERIAL HWY # HB223
DOWNEY CA
90242-3456
US

V. Phone/Fax

Practice location:
  • Phone: 562-385-7061
  • Fax: 562-385-6690
Mailing address:
  • Phone: 562-385-7061
  • Fax: 562-385-6690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT15611
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: