Provider Demographics
NPI:1740525922
Name:THOMPSON, MARY GUYTON (LPTA)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:GUYTON
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2350 LEN CIR NW
Mailing Address - Street 2:
Mailing Address - City:HARTSELLE
Mailing Address - State:AL
Mailing Address - Zip Code:35640-7769
Mailing Address - Country:US
Mailing Address - Phone:256-751-3528
Mailing Address - Fax:
Practice Address - Street 1:2350 LEN CIR NW
Practice Address - Street 2:
Practice Address - City:HARTSELLE
Practice Address - State:AL
Practice Address - Zip Code:35640-7769
Practice Address - Country:US
Practice Address - Phone:256-751-3528
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-29
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTA4696225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant