Provider Demographics
NPI:1235969445
Name:THOMPSON, COREY (PTA)
Entity type:Individual
Prefix:
First Name:COREY
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 SUPERIOR DR STE 225
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR
Mailing Address - State:CO
Mailing Address - Zip Code:80027-8661
Mailing Address - Country:US
Mailing Address - Phone:303-665-2603
Mailing Address - Fax:
Practice Address - Street 1:3 SUPERIOR DR STE 225
Practice Address - Street 2:
Practice Address - City:SUPERIOR
Practice Address - State:CO
Practice Address - Zip Code:80027-8661
Practice Address - Country:US
Practice Address - Phone:303-665-2603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-02
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTA.0015540225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant