Provider Demographics
NPI:1457500563
Name:THOMPSON, MARY WEBB (PT, DPT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:WEBB
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1427 W BADDOUR PKWY STE A
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-3062
Mailing Address - Country:US
Mailing Address - Phone:615-444-1408
Mailing Address - Fax:615-444-1393
Practice Address - Street 1:1409 W BADDOUR PKWY
Practice Address - Street 2:SUITE A
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-2599
Practice Address - Country:US
Practice Address - Phone:615-444-1408
Practice Address - Fax:615-444-1393
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-12
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8179225100000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3727276OtherGROUP MEDICARE LEGACY NUMBER
TN3727276OtherGROUP MEDICAID LEGACY NUMBER