Healthcare Provider Details

I. General information

NPI: 1548508328
Provider Name (Legal Business Name): ROBERT WILLIAM THOMPSON PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2013
Last Update Date: 02/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 S INDEPENDENCE AVE
INDEPENDENCE VA
24348-3972
US

IV. Provider business mailing address

500 DOVER ST
MARION VA
24354-1855
US

V. Phone/Fax

Practice location:
  • Phone: 276-773-9447
  • Fax: 276-773-9447
Mailing address:
  • Phone: 276-233-1521
  • Fax: 276-773-9447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2306602148
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: