Provider Demographics
NPI:1922243500
Name:THOMPSON, LATONYA S (PTA)
Entity Type:Individual
Prefix:
First Name:LATONYA
Middle Name:S
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10015 OLD COLUMBIA RD
Mailing Address - Street 2:SUITE B 215
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046-1703
Mailing Address - Country:US
Mailing Address - Phone:410-356-6161
Mailing Address - Fax:
Practice Address - Street 1:1840 YORK RD
Practice Address - Street 2:SUITE H
Practice Address - City:TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-5121
Practice Address - Country:US
Practice Address - Phone:410-560-6717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-10
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA2789225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant