Provider Demographics
NPI:1003176918
Name:THOMPSON, ALLISON DONNA RUTH
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:DONNA RUTH
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2244 MAZATZAL
Mailing Address - Street 2:
Mailing Address - City:SHOW LOW
Mailing Address - State:AZ
Mailing Address - Zip Code:85901-7042
Mailing Address - Country:US
Mailing Address - Phone:928-713-6311
Mailing Address - Fax:
Practice Address - Street 1:5171 CUB LAKE RD STE 310
Practice Address - Street 2:
Practice Address - City:SHOW LOW
Practice Address - State:AZ
Practice Address - Zip Code:85901-7888
Practice Address - Country:US
Practice Address - Phone:928-537-0248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-24
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9692A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant