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General NPI Number Information
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NPI Number | 1003176918
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Entity Type | Individual
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Provider Name | ALLISON DONNA RUTH THOMPSON
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Gender | Female
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Dates
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Enumeration Date | 05/24/2012
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Last Update Date | 01/16/2013
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Provider Practice Location Address
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Address Line | 5171 CUB LAKE RD STE 310
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City | SHOW LOW
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State | AZ
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Zip | 85901-7888
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Country | US
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Telephone | 928-537-0248
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Fax |
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Provider Business Mailing Address
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Address Line | 2244 MAZATZAL
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City | SHOW LOW
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State | AZ
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Zip | 85901-7042
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Country | US
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Telephone | 928-713-6311
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 9692A
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License Number State | AZ
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