Individual
KENNETH THOMPSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
5416 FLORENCE AVE, PHILADELPHIA, PA 19143-4139
(267) 826-6125
Mailing address
5416 FLORENCE AVE, PHILADELPHIA, PA 19143-4139
(267) 826-6125
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
—
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1039407360001
—
PA
Enumeration date
01/04/2022
Last updated
01/04/2022
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