Provider Demographics
NPI:1396058764
Name:THOMPSON, AUDRA RENEE
Entity type:Individual
Prefix:
First Name:AUDRA
Middle Name:RENEE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:427 HAVERLY ST
Mailing Address - Street 2:
Mailing Address - City:CRESTED BUTTE
Mailing Address - State:CO
Mailing Address - Zip Code:81224-9613
Mailing Address - Country:US
Mailing Address - Phone:970-596-0286
Mailing Address - Fax:
Practice Address - Street 1:427 HAVERLY ST
Practice Address - Street 2:
Practice Address - City:CRESTED BUTTE
Practice Address - State:CO
Practice Address - Zip Code:81224-9613
Practice Address - Country:US
Practice Address - Phone:970-596-0286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-14
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist