Healthcare Provider Details

I. General information

NPI: 1619391927
Provider Name (Legal Business Name): CARRIE LEE THOMPSON P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2014
Last Update Date: 02/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 N MILLER RD STE 150A
FAIRLAWN OH
44333-3713
US

IV. Provider business mailing address

81 CHEYENNE DR
RITTMAN OH
44270-1289
US

V. Phone/Fax

Practice location:
  • Phone: 330-630-1860
  • Fax: 330-630-3198
Mailing address:
  • Phone: 330-607-4237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT010631
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: