Wallace Lee Thompson

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

TE1003187 Issued in PA

Practice address

100 Saint Francis Dr
Bradford, PA 16701-1868

Phone

(814) 688-1531

NPI assigned

Apr 14, 2018

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1523664000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1523664000000",
    "number": "1306333422",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "763 PRIEST HOLLOW RD",
            "city": "RUSSELL",
            "state": "PA",
            "postal_code": "163454633",
            "telephone_number": "814-688-1531"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 SAINT FRANCIS DR",
            "city": "BRADFORD",
            "state": "PA",
            "postal_code": "167011868",
            "telephone_number": "814-688-1531"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THOMPSON",
        "first_name": "WALLACE",
        "middle_name": "LEE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-04-14",
        "last_updated": "2018-04-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "PA",
            "license": "TE1003187",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• The Guidance Center
• The Guidance Center
• The Guidance Center
• The Guidance Center
• Chelsea Thompson, OTR/L
• Ann Sassone Tommasino, CRNA
• Town Center Woman'S Care PC
• Tri- County Diagnostic Testing Services LLC
• Thomas J Tupper, PT
• Twintier Physical Rehab, LLC

• All providers in Bradford, PA
• Physical Therapy Assistant in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.