Provider Demographics
NPI:1174336663
Name:THOMPSON, GERALD B (LMT, RYT)
Entity type:Individual
Prefix:MR
First Name:GERALD
Middle Name:B
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:LMT, RYT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11103 AULDINE DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-4315
Mailing Address - Country:US
Mailing Address - Phone:210-262-8856
Mailing Address - Fax:
Practice Address - Street 1:8915 BANDERA RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78250-2517
Practice Address - Country:US
Practice Address - Phone:210-262-8856
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-29
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171400000X
TXMT142335225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No171400000XOther Service ProvidersHealth & Wellness Coach