Provider Demographics
NPI:1649730185
Name:THOMPSON, CARLY NICOLE (DPT)
Entity type:Individual
Prefix:
First Name:CARLY
Middle Name:NICOLE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:CARLY
Other - Middle Name:
Other - Last Name:SCHEID
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:637 TIFFANY TRL
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-5619
Mailing Address - Country:US
Mailing Address - Phone:812-243-0646
Mailing Address - Fax:
Practice Address - Street 1:637 TIFFANY TRL
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-5619
Practice Address - Country:US
Practice Address - Phone:214-699-9238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-21
Last Update Date:2025-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1302930225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist