Provider Demographics
NPI:1477166304
Name:THOMPSON, TIA-ANN
Entity Type:Individual
Prefix:
First Name:TIA-ANN
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2435 MONTGOMERY RD APT 214
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77340-6062
Mailing Address - Country:US
Mailing Address - Phone:214-866-5802
Mailing Address - Fax:
Practice Address - Street 1:2435 MONTGOMERY RD APT 214
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77340-6062
Practice Address - Country:US
Practice Address - Phone:214-866-5802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-29
Last Update Date:2021-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer