Provider Demographics
NPI:1932304854
Name:THOMPSON, CLIFFORD WAYNE
Entity Type:Individual
Prefix:MR
First Name:CLIFFORD
Middle Name:WAYNE
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2328
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40743-2328
Mailing Address - Country:US
Mailing Address - Phone:606-877-3950
Mailing Address - Fax:606-877-3956
Practice Address - Street 1:740 E LAUREL RD
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-8601
Practice Address - Country:US
Practice Address - Phone:606-877-3950
Practice Address - Fax:606-877-3956
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA01114225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYA01114OtherSTATE LICENSE