Provider Demographics
NPI:1881029817
Name:THOMPSON, SARAH KAYE (ATC, LAT, PES)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:KAYE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:ATC, LAT, PES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7950 HENRY AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-3010
Mailing Address - Country:US
Mailing Address - Phone:845-594-7240
Mailing Address - Fax:
Practice Address - Street 1:311 N 19TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-1102
Practice Address - Country:US
Practice Address - Phone:845-594-7240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-10
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA152853146N00000X
PA20000103602255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic