MEDICARE: JUSTIN WILLIAM THOMPSON

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	4060	OK

General Provider Information

NPI Number	:	1376261974
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUSTIN WILLIAM THOMPSON

Provider Business Mailing Address
First Line	:	1913 QUAIL RD
Second Line	:
City	:	MARLOW
State	:	OK
Zip	:	73055-9785
Country	:	US
Telephone Number	:	580-465-1829
Fax Number	:

Provider Business Practice Location Address
First Line	:	1700 NW FORT SILL BLVD
Second Line	:
City	:	LAWTON
State	:	OK
Zip	:	73507-4064
Country	:	US
Telephone Number	:	580-465-1829
Fax Number	:

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

Provider Enumeration Date	:	08/19/2022
Last Update Date	:	08/19/2022

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Directions to “ JUSTIN WILLIAM THOMPSON ” Practice Location

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