Provider Demographics
NPI:1730464595
Name:THOMPSON, KYE S (LMT)
Entity Type:Individual
Prefix:MRS
First Name:KYE
Middle Name:S
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7000 N 16TH STREET
Mailing Address - Street 2:SUITE 120 #328
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020
Mailing Address - Country:US
Mailing Address - Phone:480-553-2781
Mailing Address - Fax:888-519-7130
Practice Address - Street 1:7000 N 16TH STREET
Practice Address - Street 2:SUITE 120 #328
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-5506
Practice Address - Country:US
Practice Address - Phone:480-553-2781
Practice Address - Fax:888-519-7130
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-12
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-14601225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist