Provider Demographics
NPI:1467462127
Name:THOMPSON, SCOTT JAKE (PT, ATC)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:JAKE
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:PT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2751 2ND AVE N STOP 9013
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58202-9013
Mailing Address - Country:US
Mailing Address - Phone:701-777-4845
Mailing Address - Fax:701-777-2536
Practice Address - Street 1:2751 2ND AVE N STOP 9013
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58202-9013
Practice Address - Country:US
Practice Address - Phone:701-777-4845
Practice Address - Fax:701-777-2536
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2017-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1477225100000X, 2081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND45-6002491OtherTAX-ID