Provider Demographics
NPI:1164745287
Name:THOMPSON, MARILYN DENISE (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:MARILYN
Middle Name:DENISE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 W CALIFORNIA AVE
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92083-3622
Mailing Address - Country:US
Mailing Address - Phone:760-724-0831
Mailing Address - Fax:760-631-0652
Practice Address - Street 1:215 W CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083-3622
Practice Address - Country:US
Practice Address - Phone:760-724-0831
Practice Address - Fax:760-631-0652
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-03
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT14860225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist