Provider Demographics
NPI:1215449517
Name:THOMPSON, SEAN M SR (MASSAGE THERAPIST)
Entity type:Individual
Prefix:MR
First Name:SEAN
Middle Name:M
Last Name:THOMPSON
Suffix:SR
Gender:M
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 GUS HIPP BLVD STE 3
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4821
Mailing Address - Country:US
Mailing Address - Phone:321-216-7166
Mailing Address - Fax:
Practice Address - Street 1:550 GUS HIPP BLVD STE 3
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-4821
Practice Address - Country:US
Practice Address - Phone:321-216-7166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-27
Last Update Date:2017-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA63761225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist