Provider Demographics
NPI:1659087559
Name:THOMPSON, LEAH
Entity Type:Individual
Prefix:
First Name:LEAH
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 1:5201 ROSS RD
Mailing Address - Street 2:
Mailing Address - City:DEL VALLE
Mailing Address - State:TX
Mailing Address - Zip Code:78617-3202
Mailing Address - Country:US
Mailing Address - Phone:812-630-6122
Mailing Address - Fax:
Practice Address - Street 1:5201 ROSS RD
Practice Address - Street 2:
Practice Address - City:DEL VALLE
Practice Address - State:TX
Practice Address - Zip Code:78617-3202
Practice Address - Country:US
Practice Address - Phone:512-386-3261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-25
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT43272255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer