Healthcare Provider Details

I. General information

NPI: 1841254091
Provider Name (Legal Business Name): CRAIG AARON THOMPSON PT
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 N 2ND ST
CLINTON MO
64735-1192
US

IV. Provider business mailing address

140 SE HWY AA
CLINTON MO
64735-9444
US

V. Phone/Fax

Practice location:
  • Phone: 660-885-5511
  • Fax: 660-885-5640
Mailing address:
  • Phone: 660-885-5511
  • Fax: 660-885-5640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number110984
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: