Provider Demographics
NPI:1093025041
Name:THOMPSON, JENNIFER ALETHEA (PTA)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ALETHEA
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1143 PIT ROAD
Mailing Address - Street 2:
Mailing Address - City:JAVA CENTER
Mailing Address - State:NY
Mailing Address - Zip Code:14082
Mailing Address - Country:US
Mailing Address - Phone:585-457-4035
Mailing Address - Fax:
Practice Address - Street 1:1143 PIT RD.
Practice Address - Street 2:
Practice Address - City:JAVA CENTER
Practice Address - State:NY
Practice Address - Zip Code:14082
Practice Address - Country:US
Practice Address - Phone:585-457-4035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-08
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004330-1225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant