Healthcare Provider Details

I. General information

NPI: 1972331775
Provider Name (Legal Business Name): NATALIE ASHTON THOMPSON LPTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2024
Last Update Date: 07/23/2024
Certification Date: 07/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 BROOKWAY BLVD
BROOKHAVEN MS
39601-3266
US

IV. Provider business mailing address

314 MAIN ST STE C
MONTICELLO MS
39654-3702
US

V. Phone/Fax

Practice location:
  • Phone: 601-833-7317
  • Fax:
Mailing address:
  • Phone: 601-587-2563
  • Fax: 601-587-0472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA-7822
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: