Provider Demographics
NPI:1578951471
Name:THOMPSON, DAYLENE
Entity Type:Individual
Prefix:MRS
First Name:DAYLENE
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 1:7660 WYNGATE ST
Mailing Address - Street 2:
Mailing Address - City:TUJUNGA
Mailing Address - State:CA
Mailing Address - Zip Code:91042-1736
Mailing Address - Country:US
Mailing Address - Phone:818-352-1454
Mailing Address - Fax:818-352-4922
Practice Address - Street 1:7660 WYNGATE ST
Practice Address - Street 2:
Practice Address - City:TUJUNGA
Practice Address - State:CA
Practice Address - Zip Code:91042-1736
Practice Address - Country:US
Practice Address - Phone:818-352-1454
Practice Address - Fax:818-352-4922
Is Sole Proprietor?:No
Enumeration Date:2014-12-30
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT2626225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant