Provider Demographics
NPI:1619335270
Name:THOMPSON, KAYSHA (LPTA)
Entity Type:Individual
Prefix:
First Name:KAYSHA
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2422 N THOMPSON ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72764-1757
Mailing Address - Country:US
Mailing Address - Phone:479-757-5010
Mailing Address - Fax:479-927-0489
Practice Address - Street 1:2422 N THOMPSON ST
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-1757
Practice Address - Country:US
Practice Address - Phone:479-757-5010
Practice Address - Fax:479-927-0489
Is Sole Proprietor?:No
Enumeration Date:2016-02-10
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPTA 1289225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant