Provider Demographics
NPI:1497054001
Name:THOMPSON, JENNIFER N (PT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:N
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2030 CECIL ASHBURN DR SE
Mailing Address - Street 2:#100
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35802-2561
Mailing Address - Country:US
Mailing Address - Phone:256-880-7776
Mailing Address - Fax:256-880-7708
Practice Address - Street 1:4087 HIGHWAY 31 SW
Practice Address - Street 2:
Practice Address - City:FALKVILLE
Practice Address - State:AL
Practice Address - Zip Code:35622-6319
Practice Address - Country:US
Practice Address - Phone:256-784-6197
Practice Address - Fax:256-784-5104
Is Sole Proprietor?:No
Enumeration Date:2011-03-22
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH6061225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL010534OtherBC GROUP
AL1427045673OtherGROUP NPI
AL1003819608OtherGROUP NPI
AL529917620Medicaid
AL1003819608OtherGROUP NPI
AL1427045673OtherGROUP NPI