Provider Demographics
NPI:1427708833
Name:THOMPSON, KELLY (PTA)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 ALVORD PARK RD STE A2
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06790-7217
Mailing Address - Country:US
Mailing Address - Phone:860-482-8539
Mailing Address - Fax:860-482-0258
Practice Address - Street 1:245 ALVORD PARK RD STE A2
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790-7217
Practice Address - Country:US
Practice Address - Phone:860-482-8539
Practice Address - Fax:860-482-0258
Is Sole Proprietor?:No
Enumeration Date:2022-03-28
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000883225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant