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General NPI Number Information
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NPI Number | 1891274502
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Entity Type | Individual
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Provider Name | SAVANNAH THOMPSON
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Gender | Female
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Dates
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Enumeration Date | 08/13/2018
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Last Update Date | 08/13/2018
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Provider Practice Location Address
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Address Line | 2212 W REAGAN ST
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City | PALESTINE
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State | TX
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Zip | 75801-2222
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Country | US
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Telephone | 903-727-8500
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Fax |
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Provider Business Mailing Address
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Address Line | 131 CLEARVIEW DR
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City | PALESTINE
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State | TX
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Zip | 75803-5615
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Country | US
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Telephone | 402-210-1779
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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 | 2091999
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License Number State | TX
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