Provider Demographics
NPI:1922439538
Name:THOMPSON, SONYA GLEN (CMP)
Entity Type:Individual
Prefix:MS
First Name:SONYA
Middle Name:GLEN
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:CMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1240 7TH AVE APT 16
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94122-2532
Mailing Address - Country:US
Mailing Address - Phone:415-516-4956
Mailing Address - Fax:
Practice Address - Street 1:1240 7TH AVE APT 16
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94122-2532
Practice Address - Country:US
Practice Address - Phone:415-516-4956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-06
Last Update Date:2013-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55322225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist