Healthcare Provider Details

I. General information

NPI: 1285246363
Provider Name (Legal Business Name): DR. CHRISTOPHER BENJAMIN THOMPSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2020
Last Update Date: 08/19/2020
Certification Date: 08/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 E HIGHWAY 550 STE E3
BERNALILLO NM
87004-5943
US

IV. Provider business mailing address

709 PALOMAS DR NE
ALBUQUERQUE NM
87108-1629
US

V. Phone/Fax

Practice location:
  • Phone: 505-404-8652
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT5760
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: