Healthcare Provider Details

I. General information

NPI: 1891869749
Provider Name (Legal Business Name): MRS. BOBBIE JEAN THOMPSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 SEMINOLE CT
CHARLOTTESVILLE VA
22901-2848
US

IV. Provider business mailing address

BOBBIE JEAN THOMPSON 34 CANTERBURY RD
CHARLOTTESVILLE VA
22903-4702
US

V. Phone/Fax

Practice location:
  • Phone: 434-974-7500
  • Fax: 434-984-6243
Mailing address:
  • Phone: 434-971-3560
  • Fax: 434-984-6243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberCC19698947
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: