Provider Demographics
NPI:1831354422
Name:THOMPSON, KELLY STEPHENSON (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:STEPHENSON
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:EVA
Other - Last Name:STEPHENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHYSICAL THERAPIST
Mailing Address - Street 1:728 PINEY GROVE RD
Mailing Address - Street 2:
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284-2335
Mailing Address - Country:US
Mailing Address - Phone:336-996-5866
Mailing Address - Fax:
Practice Address - Street 1:728 PINEY GROVE RD
Practice Address - Street 2:
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-2335
Practice Address - Country:US
Practice Address - Phone:336-996-5866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-23
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2306225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist