Healthcare Provider Details

I. General information

NPI: 1225761893
Provider Name (Legal Business Name): CHLOE M THOMPSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHLOE M THOMPSON PTA

II. Dates (important events)

Enumeration Date: 07/01/2022
Last Update Date: 07/11/2022
Certification Date: 07/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 S LAWRENCE BLVD
KEYSTONE HEIGHTS FL
32656-9222
US

IV. Provider business mailing address

3895 DARLENE RD
MIDDLEBURG FL
32068-7216
US

V. Phone/Fax

Practice location:
  • Phone: 352-473-7560
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA22423
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: