=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891167946
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TARA MARIE THOMPSON DPT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/28/2015
-----------------------------------------------------
Last Update Date | 09/10/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 110 N MONTANA ST
-----------------------------------------------------
City | DILLON
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59725-3308
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-988-0155
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 110 N MONTANA ST
-----------------------------------------------------
City | DILLON
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59725-3308
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-988-0155
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2251C2600X
-----------------------------------------------------
Taxonomy Name | Cardiopulmonary Physical Therapist
-----------------------------------------------------
License Number | PTP-PT-LIC-9377
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 9377
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------