=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114325719
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SANDRA MARIE THOMPSON LMT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/12/2014
-----------------------------------------------------
Last Update Date | 12/12/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1005 IDAHO AVE
-----------------------------------------------------
City | NATRONA HEIGHTS
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15065-1343
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-904-7356
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 272 HANNAHSTOWN RD
-----------------------------------------------------
City | CABOT
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16023-2118
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-814-2784
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | MSG009502
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------