Provider Demographics
NPI:1487807566
Name:THOMPSON, ELIZABETH SUE
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:SUE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TEXAS
Other - Middle Name:02
Other - Last Name:TESTING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:229 HARRIS LN
Mailing Address - Street 2:
Mailing Address - City:YANTIS
Mailing Address - State:TX
Mailing Address - Zip Code:75497-9730
Mailing Address - Country:US
Mailing Address - Phone:903-383-2860
Mailing Address - Fax:903-383-7975
Practice Address - Street 1:229 HARRIS LN
Practice Address - Street 2:
Practice Address - City:YANTIS
Practice Address - State:TX
Practice Address - Zip Code:75497-9730
Practice Address - Country:US
Practice Address - Phone:903-383-2860
Practice Address - Fax:903-383-7975
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-03
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51264227800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Certified
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1991267-03Medicaid
TX1991267-04OtherCSN MEDICAID
TXP00733683OtherRAILROAD MEDICARE PTAN
TXFTP017OtherMEDICARE PTAN