Provider Demographics
NPI:1508480567
Name:THOMPSON, NEILY (PT, DPT)
Entity Type:Individual
Prefix:
First Name:NEILY
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 MONTGOMERY AVE STE 310
Mailing Address - Street 2:
Mailing Address - City:PENN VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19072-1553
Mailing Address - Country:US
Mailing Address - Phone:610-660-8200
Mailing Address - Fax:
Practice Address - Street 1:915 MONTGOMERY AVE STE 310
Practice Address - Street 2:
Practice Address - City:PENN VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19072-1553
Practice Address - Country:US
Practice Address - Phone:610-660-8200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-04
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT02844852251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics