Individual
LISA M THOMPSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
1319 W HAVENS AVE, MITCHELL, SD 57301-4116
(605) 996-4778
(605) 996-3660
Mailing address
1319 W HAVENS ST, MITCHELL, SD 57301-4116
(605) 996-4778
(605) 996-3660
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
641
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4997332
BXBS OF SD
—
05
—
5833310
—
SD
Enumeration date
03/14/2006
Last updated
11/18/2010
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