Provider Demographics
NPI:1659381499
Name:THOMPSON, STEPHEN C (MPT)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:C
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2310 W I 20
Mailing Address - Street 2:STE 204
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76017-1678
Mailing Address - Country:US
Mailing Address - Phone:817-466-7276
Mailing Address - Fax:817-466-7286
Practice Address - Street 1:2310 W I 20
Practice Address - Street 2:STE 204
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017-1678
Practice Address - Country:US
Practice Address - Phone:817-466-7276
Practice Address - Fax:817-466-7286
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1125334225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist