Provider Demographics
NPI:1700432986
Name:THOMPSON, REBECCA (PTA)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3432 EASTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50317-2710
Mailing Address - Country:US
Mailing Address - Phone:515-310-2901
Mailing Address - Fax:
Practice Address - Street 1:1300 NW 100TH ST STE 1000
Practice Address - Street 2:
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-6702
Practice Address - Country:US
Practice Address - Phone:515-276-1212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-14
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA078236225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant