Provider Demographics
NPI:1245449859
Name:THOMPSON, CHARLES ELSWORTH (ATC)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:ELSWORTH
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4441 W MCNAB RD
Mailing Address - Street 2:#20
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33069-4961
Mailing Address - Country:US
Mailing Address - Phone:954-260-7303
Mailing Address - Fax:
Practice Address - Street 1:4441 W MCNAB RD
Practice Address - Street 2:#20
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33069-4961
Practice Address - Country:US
Practice Address - Phone:954-260-7303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL20022255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer