Provider Demographics
NPI:1760654024
Name:THOMSON, MICKIE ANN (PTA)
Entity Type:Individual
Prefix:MRS
First Name:MICKIE
Middle Name:ANN
Last Name:THOMSON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:MICKIE
Other - Middle Name:ANN
Other - Last Name:WINCHEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6737 E EVANS DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-3490
Mailing Address - Country:US
Mailing Address - Phone:623-203-9199
Mailing Address - Fax:
Practice Address - Street 1:6320 W UNION HILLS DR STE A265
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-1098
Practice Address - Country:US
Practice Address - Phone:623-374-2424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-27
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7961A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant