Provider Demographics
NPI:1851115489
Name:THOMPSON, JEFFREY LYNN (PT, DPT, CWS)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:LYNN
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:PT, DPT, CWS
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 31309
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90031-0309
Mailing Address - Country:US
Mailing Address - Phone:323-865-1200
Mailing Address - Fax:
Practice Address - Street 1:1640 MARENGO ST STE 102
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-1061
Practice Address - Country:US
Practice Address - Phone:323-865-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-11
Last Update Date:2025-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT34078225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist