Provider Demographics
NPI:1245413095
Name:THOMPSON, JOEL ALLAN (OPA-C, ATC, LAT)
Entity Type:Individual
Prefix:MR
First Name:JOEL
Middle Name:ALLAN
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:OPA-C, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5279 LEBANON RD.
Mailing Address - Street 2:SUITE 144 PMB 333
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034
Mailing Address - Country:US
Mailing Address - Phone:469-304-3501
Mailing Address - Fax:469-304-3501
Practice Address - Street 1:5729 LEBANON RD.
Practice Address - Street 2:SUITE 144 PMB 333
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034
Practice Address - Country:US
Practice Address - Phone:469-304-3501
Practice Address - Fax:469-304-3501
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-14
Last Update Date:2017-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAATH.2000072255A2300X
TXAT44192255A2300X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer