Derek Chase Thompson, PTA
Individual provider Active NPI Physical Therapy Assistant · Booneville, KY
NPI 1962717017 · NPPES record last updated Aug 13, 2010
Key facts
- NPI
- 1962717017
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapy Assistant 225200000X
- License
- A02681 (KY)
- Practice address
- 200 Mulbery Street Suite C
Booneville, KY 41313 - Phone
- (606) 593-6003
- NPI assigned
- Aug 13, 2010
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A02681 | KY | MD | Physical Therapy Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mountain Physical Therapy, PLLC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | A02681 | KY | Yes |
Addresses
Primary practice location
200 Mulbery Street Suite C
Booneville, KY 41313
Mailing address
510 Regional Airport Rd
Chavies, KY 41727-8646
Phone (606) 435-8284
Other providers in Booneville, KY
- Donna Priddy
- Public Drug Company Inc
- Public Drug Company Inc
- Barbara Faye Roberts
- Sugar Camp House Adult Day Health Care
- Sharon F Ward
- Adrienne Irene Wilder
- Darlene Wilson
All providers in Booneville, KY · Physical Therapy Assistant in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 13, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.