Healthcare Provider Details

I. General information

NPI: 1487325601
Provider Name (Legal Business Name): DR. DIONNA SHUNTAE THOMPSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2021
Last Update Date: 09/27/2021
Certification Date: 09/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14207 HIGGINS RD
SAN ANTONIO TX
78217-1252
US

IV. Provider business mailing address

6201 GRISSOM RD APT 8106
SAN ANTONIO TX
78238-2266
US

V. Phone/Fax

Practice location:
  • Phone: 210-826-4492
  • Fax:
Mailing address:
  • Phone: 769-233-1588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number1339205
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: