Provider Demographics
NPI:1063514867
Name:THOMPSON, ERIC GREGORY (DPT)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:GREGORY
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5418 N EAGLE RD
Mailing Address - Street 2:STE 140
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713-0998
Mailing Address - Country:US
Mailing Address - Phone:208-938-5255
Mailing Address - Fax:208-938-5545
Practice Address - Street 1:5418 N EAGLE RD
Practice Address - Street 2:STE 140
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83713-0998
Practice Address - Country:US
Practice Address - Phone:208-938-5255
Practice Address - Fax:208-938-5545
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-2078174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist