MEDICARE: MARY WEBB THOMPSON PT, 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	225100000X	Physical Therapist	8179	TN
2	225100000X	Physical Therapist

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3727276	OTHER	TN	GROUP MEDICARE LEGACY NUMBER

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457500563
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY WEBB THOMPSON PT, DPT

Provider Business Mailing Address
First Line	:	1427 W BADDOUR PKWY STE A
Second Line	:
City	:	LEBANON
State	:	TN
Zip	:	37087-3062
Country	:	US
Telephone Number	:	615-444-1408
Fax Number	:	615-444-1393

Provider Business Practice Location Address
First Line	:	1409 W BADDOUR PKWY
Second Line	:	SUITE A
City	:	LEBANON
State	:	TN
Zip	:	37087-2599
Country	:	US
Telephone Number	:	615-444-1408
Fax Number	:	615-444-1393

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

Provider Enumeration Date	:	09/12/2008
Last Update Date	:	11/22/2021

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