Provider Demographics
NPI:1851052831
Name:THOMPSON, AMANDA ANN
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:ANN
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2726 COUNTY ROAD 1590
Mailing Address - Street 2:
Mailing Address - City:ALVORD
Mailing Address - State:TX
Mailing Address - Zip Code:76225-4045
Mailing Address - Country:US
Mailing Address - Phone:940-210-3802
Mailing Address - Fax:
Practice Address - Street 1:5796 E STATE HIGHWAY 114 STE 1A
Practice Address - Street 2:
Practice Address - City:HASLET
Practice Address - State:TX
Practice Address - Zip Code:76052-2079
Practice Address - Country:US
Practice Address - Phone:940-210-3802
Practice Address - Fax:940-535-7333
Is Sole Proprietor?:No
Enumeration Date:2022-01-03
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1234321225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist