Provider Demographics
NPI:1447409552
Name:THOMPSON, ROBERT DAVID (MPT)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:DAVID
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 TOWNSHIP ROAD 1356
Mailing Address - Street 2:
Mailing Address - City:SOUTH POINT
Mailing Address - State:OH
Mailing Address - Zip Code:45680-7506
Mailing Address - Country:US
Mailing Address - Phone:740-444-4419
Mailing Address - Fax:
Practice Address - Street 1:1540 SPRING VALLEY DRIVE
Practice Address - Street 2:VA MEDICAL CENTER
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25704
Practice Address - Country:US
Practice Address - Phone:304-429-6741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-12
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVPT002301174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist