MEDICARE: THADDEUS THOMPSON PT

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	38649	CA

General Provider Information

NPI Number	:	1811262017
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THADDEUS THOMPSON PT

Provider Business Mailing Address
First Line	:	6320 SAINT AUGUSTINE RD
Second Line	:	SUITE 1
City	:	JACKSONVILLE
State	:	FL
Zip	:	32217-2800
Country	:	US
Telephone Number	:	904-448-5075
Fax Number	:

Provider Business Practice Location Address
First Line	:	6320 SAINT AUGUSTINE RD
Second Line	:	SUITE 1
City	:	JACKSONVILLE
State	:	FL
Zip	:	32217-2800
Country	:	US
Telephone Number	:	904-448-5075
Fax Number	:

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

Provider Enumeration Date	:	03/21/2012
Last Update Date	:	05/15/2014

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Directions to “ THADDEUS THOMPSON PT” Practice Location

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