Provider Demographics
NPI:1720563661
Name:THOMPSON, STEPHANIE (LMT CNMT)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LMT CNMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6143 SIERRA GRANDE PT
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80923-3881
Mailing Address - Country:US
Mailing Address - Phone:719-258-7381
Mailing Address - Fax:
Practice Address - Street 1:5480 TOMAH DR LOWR LEVEL
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-1928
Practice Address - Country:US
Practice Address - Phone:719-396-2839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-26
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0021723225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist