Healthcare Provider Details

I. General information

NPI: 1952606295
Provider Name (Legal Business Name): BARBARA AVALON THOMPSON PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2011
Last Update Date: 01/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19531 COCHRAN BLVD
PORT CHARLOTTE FL
33948-2081
US

IV. Provider business mailing address

125 PECKHAM ST SW
PORT CHARLOTTE FL
33952-9136
US

V. Phone/Fax

Practice location:
  • Phone: 941-255-3535
  • Fax: 941-235-3418
Mailing address:
  • Phone: 941-380-0396
  • Fax: 941-235-3418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT23535
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: