MEDICARE: MR. RONALD EUGENE THOMPSON PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	11754	CA

General Provider Information

NPI Number	:	1033108394
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RONALD EUGENE THOMPSON PT

Provider Business Mailing Address
First Line	:	4300 GOLDEB CENTER DR.
Second Line	:	SUITE B
City	:	PLACERVILLE
State	:	CA
Zip	:	95667-5738
Country	:	US
Telephone Number	:	530-344-2045
Fax Number	:	530-642-0794

Provider Business Practice Location Address
First Line	:	4300 GOLDEN CENTER DR
Second Line	:	SUITE B
City	:	PLACERVILLE
State	:	CA
Zip	:	95667-6278
Country	:	US
Telephone Number	:	530-344-2045
Fax Number	:	530-642-0794

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/19/2005
Last Update Date	:	07/08/2007

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