Provider Demographics
NPI:1295568673
Name:THOMPSON, TE'ARA L (DPT)
Entity type:Individual
Prefix:
First Name:TE'ARA
Middle Name:L
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3302 WESLEY ST
Mailing Address - Street 2:
Mailing Address - City:PASCAGOULA
Mailing Address - State:MS
Mailing Address - Zip Code:39567-4535
Mailing Address - Country:US
Mailing Address - Phone:228-235-8547
Mailing Address - Fax:
Practice Address - Street 1:1650 REPUBLIC PKWY
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-6916
Practice Address - Country:US
Practice Address - Phone:972-698-1140
Practice Address - Fax:972-681-8753
Is Sole Proprietor?:No
Enumeration Date:2024-08-22
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXCP033646T225100000X
MS7838225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist