Provider Demographics
NPI:1184764979
Name:THOMPSON, PAM (PT)
Entity type:Individual
Prefix:MRS
First Name:PAM
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 W 6TH ST
Mailing Address - Street 2:PO BOX 272
Mailing Address - City:GRAFTON
Mailing Address - State:ND
Mailing Address - Zip Code:58237-1379
Mailing Address - Country:US
Mailing Address - Phone:701-352-2574
Mailing Address - Fax:701-352-0188
Practice Address - Street 1:701 W 6TH ST
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:ND
Practice Address - Zip Code:58237-1379
Practice Address - Country:US
Practice Address - Phone:701-352-2574
Practice Address - Fax:701-352-0188
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND919225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND51234Medicaid