Provider Demographics
NPI:1912762626
Name:THOMPSON, STEVEN III (PTA)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:THOMPSON
Suffix:III
Gender:M
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:PO BOX 234
Mailing Address - Street 2:
Mailing Address - City:FRIENDSHIP
Mailing Address - State:ME
Mailing Address - Zip Code:04547
Mailing Address - Country:US
Mailing Address - Phone:207-701-7841
Mailing Address - Fax:
Practice Address - Street 1:91 CAMDEN ST
Practice Address - Street 2:SUITE 107
Practice Address - City:ROCKLAND
Practice Address - State:ME
Practice Address - Zip Code:04841
Practice Address - Country:US
Practice Address - Phone:207-596-0133
Practice Address - Fax:207-596-0144
Is Sole Proprietor?:No
Enumeration Date:2024-02-21
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA6571225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant