Provider Demographics
NPI:1679806608
Name:THOMPSON, JEREMY (PT,)
Entity Type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:
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 1:2780 W HORIZON RIDGE PKWY
Mailing Address - Street 2:STE 40
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-3995
Mailing Address - Country:US
Mailing Address - Phone:702-564-4116
Mailing Address - Fax:702-932-2403
Practice Address - Street 1:2780 W HORIZON RIDGE PKWY
Practice Address - Street 2:STE 40
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-3995
Practice Address - Country:US
Practice Address - Phone:702-564-4116
Practice Address - Fax:702-932-2403
Is Sole Proprietor?:No
Enumeration Date:2009-09-09
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV090170225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV382617193OtherTIN