Individual
STACIE LONNETTE THOMPSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MPT
Contact information
Practice address
36 PROFESSIONAL PLZ, REXBURG, ID 83440-2049
(208) 359-9570
(208) 359-9580
Mailing address
325 HANSON ST, WINNEMUCCA, NV 89445-3607
(775) 625-2222
(775) 625-1131
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT 1630
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8079668
—
ID
Enumeration date
05/24/2007
Last updated
10/11/2016
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