Provider Demographics
NPI:1306000609
Name:TOMPKINS, MICHELLE HOPE (PTA)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:HOPE
Last Name:TOMPKINS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MS
Other - First Name:MICHELLE
Other - Middle Name:HOPE
Other - Last Name:JOHNS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:132 COVE CT
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-8986
Mailing Address - Country:US
Mailing Address - Phone:864-419-5664
Mailing Address - Fax:
Practice Address - Street 1:6551 PARK OF COMMERCE BLVD NW
Practice Address - Street 2:SUITE 200
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487-8218
Practice Address - Country:US
Practice Address - Phone:800-810-5344
Practice Address - Fax:800-709-4608
Is Sole Proprietor?:No
Enumeration Date:2008-07-15
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1514225200000X
NC2837225200000X
FLPTA 20110225200000X
CA8065225200000X
TX2065001225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant