Provider Demographics
NPI:1689654808
Name:THOMPSON, ANNE WEEKLEY (MSPT)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:WEEKLEY
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:
Other - Last Name:WEEKLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:124 CHERRYFIELD LN
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31419-9095
Mailing Address - Country:US
Mailing Address - Phone:912-927-3669
Mailing Address - Fax:
Practice Address - Street 1:1601 FAIR RD
Practice Address - Street 2:SUITE 100
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-1698
Practice Address - Country:US
Practice Address - Phone:912-681-7907
Practice Address - Fax:912-681-7860
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT001131225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA65BBCSRMedicare ID - Type UnspecifiedPROVIDER NUMBER