Provider Demographics
NPI:1033736590
Name:THOMPSON, AMANDA GRACE (DPT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:GRACE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1714 BAILEY ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77019-5404
Mailing Address - Country:US
Mailing Address - Phone:214-864-4015
Mailing Address - Fax:
Practice Address - Street 1:1111 HIGHWAY 6 STE 195
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-4959
Practice Address - Country:US
Practice Address - Phone:832-658-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-01
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1296231225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist