Provider Demographics
NPI:1316019524
Name:THOMPSON, LOIS E (MSPT)
Entity Type:Individual
Prefix:
First Name:LOIS
Middle Name:E
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 N. CASS AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-6401
Mailing Address - Country:US
Mailing Address - Phone:630-522-4060
Mailing Address - Fax:
Practice Address - Street 1:825 N. CASS AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559-6401
Practice Address - Country:US
Practice Address - Phone:630-522-4060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070010256225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2232480OtherBCBS GROUP NUMBER
IL2232480OtherBCBS GROUP NUMBER
ILQ56035Medicare UPIN