Provider Demographics
NPI:1760817282
Name:THOMPSON, GARY HERBERT JR (DPT)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:HERBERT
Last Name:THOMPSON
Suffix:JR
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 146
Mailing Address - Street 2:
Mailing Address - City:WOODSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08098-0146
Mailing Address - Country:US
Mailing Address - Phone:856-769-4564
Mailing Address - Fax:856-769-4637
Practice Address - Street 1:84 E GRANT ST STE 3
Practice Address - Street 2:
Practice Address - City:WOODSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08098-1400
Practice Address - Country:US
Practice Address - Phone:856-769-4564
Practice Address - Fax:856-769-4637
Is Sole Proprietor?:No
Enumeration Date:2013-09-04
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01516400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist