Provider Demographics
NPI:1699356055
Name:THOMPSON, JEFFREY RANN
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:RANN
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 RIDGEWOOD AVE APT 5
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55403-3579
Mailing Address - Country:US
Mailing Address - Phone:651-338-7178
Mailing Address - Fax:
Practice Address - Street 1:2937 LYNDALE AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-2171
Practice Address - Country:US
Practice Address - Phone:651-338-7178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-17
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN86-3151170Medicaid