Healthcare Provider Details

I. General information

NPI: 1063759090
Provider Name (Legal Business Name): ANI THOMPSON PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2013
Last Update Date: 01/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

585 W NEES AVE # 115
FRESNO CA
93711-6279
US

IV. Provider business mailing address

585 W NEES AVE # 115
FRESNO CA
93711-6279
US

V. Phone/Fax

Practice location:
  • Phone: 559-365-5001
  • Fax:
Mailing address:
  • Phone: 559-365-5001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberPT27273
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: