Provider Demographics
NPI:1508802398
Name:THOMPSON, CARLA SCOTT
Entity Type:Individual
Prefix:MS
First Name:CARLA
Middle Name:SCOTT
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:CARLA
Other - Middle Name:SCOTT
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPT
Mailing Address - Street 1:37421 HUNTERS RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SOLON
Mailing Address - State:OH
Mailing Address - Zip Code:44139-2534
Mailing Address - Country:US
Mailing Address - Phone:440-248-9169
Mailing Address - Fax:440-248-3105
Practice Address - Street 1:20676 SOUTHGATE PARK BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:MAPLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44137-2953
Practice Address - Country:US
Practice Address - Phone:216-663-5680
Practice Address - Fax:216-663-5690
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH001932225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist