Provider Demographics
NPI:1598905473
Name:THOMPSON, INDIA M (LMT)
Entity Type:Individual
Prefix:
First Name:INDIA
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 1:1019 STATE ROUTE 17M STE 1
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NY
Mailing Address - Zip Code:10950-1644
Mailing Address - Country:US
Mailing Address - Phone:845-781-5890
Mailing Address - Fax:845-781-7916
Practice Address - Street 1:1019 STATE ROUTE 17M STE 1
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NY
Practice Address - Zip Code:10950-1644
Practice Address - Country:US
Practice Address - Phone:845-781-5890
Practice Address - Fax:845-781-7916
Is Sole Proprietor?:No
Enumeration Date:2009-03-04
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017341-1225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist