Provider Demographics
NPI:1811151400
Name:THOMSON, JOHN E (PTA)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:E
Last Name:THOMSON
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 W GREEN MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46140-1014
Mailing Address - Country:US
Mailing Address - Phone:317-462-3311
Mailing Address - Fax:317-467-1591
Practice Address - Street 1:200 W GREEN MEADOWS DR
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:IN
Practice Address - Zip Code:46140-1014
Practice Address - Country:US
Practice Address - Phone:317-462-3311
Practice Address - Fax:317-467-1591
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-14
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06002378A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant