MEDICARE: DR. ERIC GREGORY THOMPSON DPT

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	174400000X	Specialist	PT-2078	ID

General Provider Information

NPI Number	:	1063514867
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIC GREGORY THOMPSON DPT

Provider Business Mailing Address
First Line	:	5418 N EAGLE RD
Second Line	:	STE 140
City	:	BOISE
State	:	ID
Zip	:	83713-0998
Country	:	US
Telephone Number	:	208-938-5255
Fax Number	:	208-938-5545

Provider Business Practice Location Address
First Line	:	5418 N EAGLE RD
Second Line	:	STE 140
City	:	BOISE
State	:	ID
Zip	:	83713-0998
Country	:	US
Telephone Number	:	208-938-5255
Fax Number	:	208-938-5545

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

Provider Enumeration Date	:	09/02/2006
Last Update Date	:	07/08/2007

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