Provider Demographics
NPI:1710296462
Name:THOMPSON, JON (LMT)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 W SADDLE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:CAMP VERDE
Mailing Address - State:AZ
Mailing Address - Zip Code:86322-4954
Mailing Address - Country:US
Mailing Address - Phone:928-567-7529
Mailing Address - Fax:
Practice Address - Street 1:600 W SADDLE CREEK DR
Practice Address - Street 2:
Practice Address - City:CAMP VERDE
Practice Address - State:AZ
Practice Address - Zip Code:86322-4954
Practice Address - Country:US
Practice Address - Phone:928-567-7529
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-29
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-07160225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist