Provider Demographics
NPI:1346299617
Name:THOMPSON, LAURA E (PT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:E
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301B E DEKALB ST
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:SC
Mailing Address - Zip Code:29020-4495
Mailing Address - Country:US
Mailing Address - Phone:803-432-2432
Mailing Address - Fax:803-432-1779
Practice Address - Street 1:301B E DEKALB ST
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:SC
Practice Address - Zip Code:29020-4495
Practice Address - Country:US
Practice Address - Phone:803-432-2432
Practice Address - Fax:803-432-1779
Is Sole Proprietor?:No
Enumeration Date:2006-05-06
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5032225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCTH1705Medicaid