Provider Demographics
NPI:1649798596
Name:THOMPSON, RAESHETTA N (HAIR REPLACEMENT)
Entity type:Individual
Prefix:
First Name:RAESHETTA
Middle Name:N
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:HAIR REPLACEMENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4245 N CENTRAL EXPY STE 490
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75205-4231
Mailing Address - Country:US
Mailing Address - Phone:937-701-1006
Mailing Address - Fax:
Practice Address - Street 1:4245 N CENTRAL EXPY STE 490
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75205-4231
Practice Address - Country:US
Practice Address - Phone:866-631-0210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-30
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No374700000XNursing Service Related ProvidersTechnician