MEDICARE: MR. IRWIN SCOTT THOMPSON MPT

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	PT32131	CA

General Provider Information

NPI Number	:	1285839175
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. IRWIN SCOTT THOMPSON MPT

Provider Business Mailing Address
First Line	:	6585 RIVER RD
Second Line	:
City	:	FORESTVILLE
State	:	CA
Zip	:	95436-9804
Country	:	US
Telephone Number	:	206-295-7964
Fax Number	:

Provider Business Practice Location Address
First Line	:	8499 OLD REDWOOD HWY
Second Line	:	STE. 110
City	:	WINDSOR
State	:	CA
Zip	:	95492-8056
Country	:	US
Telephone Number	:	707-838-2399
Fax Number	:	707-838-2385

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

Provider Enumeration Date	:	06/19/2007
Last Update Date	:	07/08/2007

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