Provider Demographics
NPI:1467981878
Name:THOMSON, JOHN ERICK (PTA)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ERICK
Last Name:THOMSON
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4301 MCKINLEY AVE
Mailing Address - Street 2:
Mailing Address - City:GROVES
Mailing Address - State:TX
Mailing Address - Zip Code:77619-5917
Mailing Address - Country:US
Mailing Address - Phone:409-719-6079
Mailing Address - Fax:
Practice Address - Street 1:4301 MCKINLEY AVE
Practice Address - Street 2:
Practice Address - City:GROVES
Practice Address - State:TX
Practice Address - Zip Code:77619
Practice Address - Country:US
Practice Address - Phone:409-719-6079
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2042398225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant