Provider Demographics
NPI:1992920151
Name:THOMPSON, LEE ADAM (L M T)
Entity type:Individual
Prefix:MR
First Name:LEE
Middle Name:ADAM
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:L M T
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 18858
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32417-8858
Mailing Address - Country:US
Mailing Address - Phone:850-628-7633
Mailing Address - Fax:850-215-8398
Practice Address - Street 1:10720 HUTCHISON BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32407-3708
Practice Address - Country:US
Practice Address - Phone:850-628-7633
Practice Address - Fax:850-215-8398
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-14
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA27463225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist