Provider Demographics
NPI:1285839175
Name:THOMPSON, IRWIN SCOTT (MPT)
Entity Type:Individual
Prefix:MR
First Name:IRWIN
Middle Name:SCOTT
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6585 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:FORESTVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95436-9804
Mailing Address - Country:US
Mailing Address - Phone:206-295-7964
Mailing Address - Fax:
Practice Address - Street 1:8499 OLD REDWOOD HWY
Practice Address - Street 2:STE. 110
Practice Address - City:WINDSOR
Practice Address - State:CA
Practice Address - Zip Code:95492-8056
Practice Address - Country:US
Practice Address - Phone:707-838-2399
Practice Address - Fax:707-838-2385
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT32131225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA056831Medicare ID - Type UnspecifiedREHAB AGENCY