Provider Demographics
NPI:1104104066
Name:THOMPSON, SAMUEL WESLEY JR (ATC)
Entity type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:WESLEY
Last Name:THOMPSON
Suffix:JR
Gender:M
Credentials:ATC
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7005 EVERSFIELD DR
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-1048
Mailing Address - Country:US
Mailing Address - Phone:443-366-1760
Mailing Address - Fax:
Practice Address - Street 1:379 FIELD HOUSE DR
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:MD
Practice Address - Zip Code:20742-0001
Practice Address - Country:US
Practice Address - Phone:301-314-7340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-26
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer