Provider Demographics
NPI:1114059730
Name:THOMPSON, PATRICIA RAE (PTA)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:RAE
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 1:11622 KNOBCREST DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-2503
Mailing Address - Country:US
Mailing Address - Phone:281-257-1281
Mailing Address - Fax:
Practice Address - Street 1:18220 STATE HIGHWAY 249
Practice Address - Street 2:STE. 150
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-4347
Practice Address - Country:US
Practice Address - Phone:281-477-4746
Practice Address - Fax:281-477-2990
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2040962225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant