Provider Demographics
NPI:1972534675
Name:THOMPSON, KEITH ERIC (ATC, CSCS)
Entity Type:Individual
Prefix:MR
First Name:KEITH
Middle Name:ERIC
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7536 LEW HOAD AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-1741
Mailing Address - Country:US
Mailing Address - Phone:225-767-6888
Mailing Address - Fax:
Practice Address - Street 1:7536 LEW HOAD AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-1741
Practice Address - Country:US
Practice Address - Phone:225-767-6888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAATH.J003582255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer