Individual
THOMAS THOMPSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3216 HOLLIDAY AVE, APOPKA, FL 32703-6636
(321) 614-0402
Mailing address
3216 HOLLIDAY AVE, APOPKA, FL 32703-6636
(321) 614-0402
Taxonomy
Speciality
Code
Description
License number
State
347C00000X
Private Vehicle
Primary
T512836864550
FL
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
11/23/2011
Last updated
11/23/2011
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