Provider Demographics
NPI:1760296065
Name:THOMPSON, ANITA MARIE (PTA)
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:MARIE
Last Name:THOMPSON
Suffix:
Gender:
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:274 CENTERVILLE RD
Mailing Address - Street 2:
Mailing Address - City:MINERAL
Mailing Address - State:VA
Mailing Address - Zip Code:23117-4601
Mailing Address - Country:US
Mailing Address - Phone:540-205-0740
Mailing Address - Fax:
Practice Address - Street 1:8003 FRANKLIN FARMS DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-5107
Practice Address - Country:US
Practice Address - Phone:804-945-0577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-05
Last Update Date:2025-02-27
Deactivation Date:2025-02-05
Deactivation Code:
Reactivation Date:2025-02-24
Provider Licenses
StateLicense IDTaxonomies
VA2306605586225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty