Provider Demographics
NPI:1255942264
Name:THOMPSON, XAVIER (MS, ATC)
Entity type:Individual
Prefix:MR
First Name:XAVIER
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 EMMET ST S RM 222
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903-2455
Mailing Address - Country:US
Mailing Address - Phone:434-924-6184
Mailing Address - Fax:
Practice Address - Street 1:210 EMMET ST S RM 222
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-2455
Practice Address - Country:US
Practice Address - Phone:434-924-6184
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-13
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260028132255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer