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General NPI Number Information
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NPI Number | 1770961856
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Entity Type | Individual
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Provider Name | LLEWELLYN THOMPSON III PTA
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Gender | Male
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Dates
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Enumeration Date | 05/11/2015
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Last Update Date | 05/11/2015
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Provider Practice Location Address
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Address Line | 395 OYSTER POINT BLVD SUITE 202
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City | SOUTH SAN FRANCISCO
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State | CA
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Zip | 94080-1928
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Country | US
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Telephone | 866-758-4700
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Fax | 866-758-4711
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Provider Business Mailing Address
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Address Line | 717 GRAND VIEW AVE
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City | SAN FRANCISCO
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State | CA
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Zip | 94114-3509
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Country | US
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Telephone | 954-579-3081
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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 | 9680
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License Number State | CA
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