Healthcare Provider Details

I. General information

NPI: 1336285360
Provider Name (Legal Business Name): STEPHEN RICHARD THOMPSON PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 05/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1355 HELICOPTER RD
VIRGINIA BEACH VA
23459-8937
US

IV. Provider business mailing address

12508 JONES MALTSBERGER RD STE 110
SAN ANTONIO TX
78247-4215
US

V. Phone/Fax

Practice location:
  • Phone: 757-763-2194
  • Fax:
Mailing address:
  • Phone: 210-590-4000
  • Fax: 210-590-4585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1168642
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: