Individual
MARIAH THOMPSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
401 15TH ST SE STE 11-12, DEMOTTE, IN 46310-9043
(219) 987-3073
Mailing address
3 BISCAYNE ST, VALPARAISO, IN 46385-7339
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05015446A
IN
Other
Enumeration date
02/01/2024
Last updated
06/14/2024
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