Individual
JOHN THOMPSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
36 BAZEBERRY RD, CORDOVA, TN 38018-7754
(901) 758-0036
Mailing address
2745 LYNCHBURG ST, MEMPHIS, TN 38134-4321
(901) 691-7371
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA0000005986
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
088118740
DRIVING LICENSE
TN
Enumeration date
04/10/2019
Last updated
04/10/2019
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