Provider Demographics
NPI:1427016401
Name:THOMPSON, STEVEN WILLIAM (MPT, OCS, CSCS)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:WILLIAM
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:MPT, OCS, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 GREENFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANSELMO
Mailing Address - State:CA
Mailing Address - Zip Code:94960-2416
Mailing Address - Country:US
Mailing Address - Phone:415-457-4454
Mailing Address - Fax:
Practice Address - Street 1:220 GREENFIELD AVE
Practice Address - Street 2:
Practice Address - City:SAN ANSELMO
Practice Address - State:CA
Practice Address - Zip Code:94960-2416
Practice Address - Country:US
Practice Address - Phone:415-457-4454
Practice Address - Fax:415-457-4944
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT206742251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT2067400Medicare PIN
CAOPT206740Medicare ID - Type UnspecifiedPHYSICAL THERAPY LICENSE