Provider Demographics
NPI:1013085182
Name:THOMPSON, TERRY (C-PED)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:C-PED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 VILLAGE PLZ
Mailing Address - Street 2:
Mailing Address - City:COLUMBIANA
Mailing Address - State:OH
Mailing Address - Zip Code:44408-8480
Mailing Address - Country:US
Mailing Address - Phone:330-482-4005
Mailing Address - Fax:330-482-3703
Practice Address - Street 1:1115 VILLAGE PLZ
Practice Address - Street 2:
Practice Address - City:COLUMBIANA
Practice Address - State:OH
Practice Address - Zip Code:44408-8480
Practice Address - Country:US
Practice Address - Phone:330-482-4005
Practice Address - Fax:330-482-3703
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50079927332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies