Provider Demographics
NPI:1750761664
Name:THOMPSON, LISA MARIE (DPT)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
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 1:8872 PROFESSIONAL DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:CADILLAC
Mailing Address - State:MI
Mailing Address - Zip Code:49601-8481
Mailing Address - Country:US
Mailing Address - Phone:231-876-0010
Mailing Address - Fax:231-876-1246
Practice Address - Street 1:8872 PROFESSIONAL DR
Practice Address - Street 2:SUITE C
Practice Address - City:CADILLAC
Practice Address - State:MI
Practice Address - Zip Code:49601-8481
Practice Address - Country:US
Practice Address - Phone:231-876-0010
Practice Address - Fax:231-876-1246
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-05
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501017227225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist