Provider Demographics
NPI:1659312270
Name:THOMPSON, CHAD MCKINLEY (PT)
Entity Type:Individual
Prefix:MR
First Name:CHAD
Middle Name:MCKINLEY
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 EASTSIDE DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-8763
Mailing Address - Country:US
Mailing Address - Phone:502-867-0111
Mailing Address - Fax:502-867-0041
Practice Address - Street 1:101 EASTSIDE DR
Practice Address - Street 2:SUITE A
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-8763
Practice Address - Country:US
Practice Address - Phone:502-867-0111
Practice Address - Fax:502-867-0041
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2013-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3250174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist