Provider Demographics
NPI:1417942889
Name:THOMPSON, ADAM J (PHD, ATC, LAT)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:J
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:PHD, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 S WASHINGTON ST
Mailing Address - Street 2:RECREATION & WELLNESS CENTER
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46953-4974
Mailing Address - Country:US
Mailing Address - Phone:765-677-2335
Mailing Address - Fax:765-677-2328
Practice Address - Street 1:4201 S WASHINGTON ST
Practice Address - Street 2:RECREATION & WELLNESS CENTER
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46953-4974
Practice Address - Country:US
Practice Address - Phone:765-677-2335
Practice Address - Fax:765-677-2328
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36000570A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer