Healthcare Provider Details

I. General information

NPI: 1306000609
Provider Name (Legal Business Name): MICHELLE HOPE TOMPKINS PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE HOPE JOHNS PTA

II. Dates (important events)

Enumeration Date: 07/15/2008
Last Update Date: 07/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6551 PARK OF COMMERCE BLVD NW SUITE 200
BOCA RATON FL
33487-8218
US

IV. Provider business mailing address

132 COVE CT
IRMO SC
29063-8986
US

V. Phone/Fax

Practice location:
  • Phone: 800-810-5344
  • Fax: 800-709-4608
Mailing address:
  • Phone: 864-419-5664
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number1514
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2837
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA 20110
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number8065
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2065001
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: