Provider Demographics
NPI:1922191451
Name:THOMPSON, MARILYN L (PT)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:L
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 FOURTH W #206
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28729
Mailing Address - Country:US
Mailing Address - Phone:828-225-1609
Mailing Address - Fax:828-251-6911
Practice Address - Street 1:852 MERRIMON AVE
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28804-2405
Practice Address - Country:US
Practice Address - Phone:828-251-6091
Practice Address - Fax:828-251-6911
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC872225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC07902OtherBCBS INDIVIDUAL NUMBER
NC872OtherPHYSICAL THERAPIST
NC7210587Medicaid