MEDICARE: MICHELLE 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	PT013241L	PA
2	225100000X	Physical Therapist	J100001445	DE
3	225100000X	Physical Therapist	21462	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	61809611	OTHER	MD	CAREFIRST
2	2003131000	OTHER	PA	AMERIHEALTH
3	11416966	OTHER		CAQH
4	1327049	OTHER		PABS
5	5070-0033	OTHER	MD	CAREFIRST

General Provider Information

NPI Number	:	1508808023
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE THOMPSON MPT

Provider Business Mailing Address
First Line	:	2122 YORK RD STE 300
Second Line	:
City	:	OAK BROOK
State	:	IL
Zip	:	60523-1925
Country	:	US
Telephone Number	:
Fax Number	:	410-648-4878

Provider Business Practice Location Address
First Line	:	2540 PULASKI HWY STE B
Second Line	:
City	:	NORTH EAST
State	:	MD
Zip	:	21901-2610
Country	:	US
Telephone Number	:	410-339-1960
Fax Number	:	443-941-9441

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

Provider Enumeration Date	:	06/11/2006
Last Update Date	:	01/30/2025

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Directions to “ MICHELLE THOMPSON MPT” Practice Location

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