Provider Demographics
NPI:1205901840
Name:THOMPSON, LEEANN (PT)
Entity type:Individual
Prefix:
First Name:LEEANN
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 1:9 EXECUTIVE PARK DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MERRIMACK
Mailing Address - State:NH
Mailing Address - Zip Code:03054-4045
Mailing Address - Country:US
Mailing Address - Phone:603-424-1950
Mailing Address - Fax:603-424-4749
Practice Address - Street 1:9 EXECUTIVE PARK DR
Practice Address - Street 2:SUITE 100
Practice Address - City:MERRIMACK
Practice Address - State:NH
Practice Address - Zip Code:03054-4045
Practice Address - Country:US
Practice Address - Phone:603-424-1950
Practice Address - Fax:603-424-4749
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1433225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH1433OtherPT LICENSE #