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General NPI Number Information
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NPI Number | 1497837322
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Entity Type | Individual
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Provider Name | MICHAEL CHARLES THOMPSON PT
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Gender | Male
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Dates
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Enumeration Date | 10/19/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 50 TRADE ROAD
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City | MASSENA
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State | NY
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Zip | 13662
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Country | US
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Telephone | 315-764-0267
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Fax | 315-764-7252
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Provider Business Mailing Address
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Address Line | 4 COTELLESSA DRIVE
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City | POTSDAM
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State | NY
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Zip | 13676-3465
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Country | US
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Telephone | 315-265-0923
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 0119351
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License Number State | NY
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