Provider Demographics
NPI:1497175004
Name:THOMPKINS, ALISA DENISE (CMT)
Entity Type:Individual
Prefix:MISS
First Name:ALISA
Middle Name:DENISE
Last Name:THOMPKINS
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1204 W 11TH ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46953-1732
Mailing Address - Country:US
Mailing Address - Phone:765-573-5854
Mailing Address - Fax:
Practice Address - Street 1:1311 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46953-1539
Practice Address - Country:US
Practice Address - Phone:765-573-5854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-22
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist