Provider Demographics
NPI:1588008411
Name:THOMPSON, KATHRYN M (LMT)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:M
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:654 E MUNGER ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05753-9087
Mailing Address - Country:US
Mailing Address - Phone:914-552-3684
Mailing Address - Fax:
Practice Address - Street 1:175 WILSON RD
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:VT
Practice Address - Zip Code:05753-8858
Practice Address - Country:US
Practice Address - Phone:914-552-3684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-22
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009832-1172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist