Provider Demographics
NPI:1891948279
Name:THOMPSON, JOSHUA STEPHEN (ATC/LAT)
Entity Type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:STEPHEN
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:ATC/LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 WESTMINSTER AVE
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MO
Mailing Address - Zip Code:65251-1230
Mailing Address - Country:US
Mailing Address - Phone:573-592-5332
Mailing Address - Fax:573-592-6211
Practice Address - Street 1:501 WESTMINSTER AVE
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:MO
Practice Address - Zip Code:65251-1230
Practice Address - Country:US
Practice Address - Phone:573-592-5332
Practice Address - Fax:573-592-6211
Is Sole Proprietor?:No
Enumeration Date:2008-10-29
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20050259742255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer