Provider Demographics
NPI:1821740820
Name:THOMPSON, BREANNA DAWN (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:BREANNA
Middle Name:DAWN
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 WILLIAMS LN
Mailing Address - Street 2:
Mailing Address - City:PURYEAR
Mailing Address - State:TN
Mailing Address - Zip Code:38251-6415
Mailing Address - Country:US
Mailing Address - Phone:731-336-6989
Mailing Address - Fax:
Practice Address - Street 1:1023 MINERAL WELLS AVE STE E
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TN
Practice Address - Zip Code:38242-4938
Practice Address - Country:US
Practice Address - Phone:731-333-3306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-20
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000012281225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist