Provider Demographics
NPI:1922017524
Name:THOMSON, MARCUS ANTHONY (PT)
Entity Type:Individual
Prefix:
First Name:MARCUS
Middle Name:ANTHONY
Last Name:THOMSON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:MARCUS
Other - Middle Name:ANTHONY
Other - Last Name:GREGERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:507 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35901-5216
Mailing Address - Country:US
Mailing Address - Phone:256-456-0563
Mailing Address - Fax:256-456-0564
Practice Address - Street 1:507 S 4TH ST
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35901-5216
Practice Address - Country:US
Practice Address - Phone:256-456-0563
Practice Address - Fax:256-456-0564
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist