Basic Information
| Provider Information | |||||||||
| NPI: | 1841254091 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THOMPSON | ||||||||
| FirstName: | CRAIG | ||||||||
| MiddleName: | AARON | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 140 SE HWY AA | ||||||||
| Address2: | |||||||||
| City: | CLINTON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 647359444 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6608855511 | ||||||||
| FaxNumber: | 6608855640 | ||||||||
| Practice Location | |||||||||
| Address1: | 1600 N 2ND ST | ||||||||
| Address2: | |||||||||
| City: | CLINTON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 647351192 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6608855511 | ||||||||
| FaxNumber: | 6608855640 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/14/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 110984 | MO | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.