Provider Demographics
NPI:1437641297
Name:THOMPSON CARPENTER, TALLEY DYAN (DPT)
Entity type:Individual
Prefix:
First Name:TALLEY
Middle Name:DYAN
Last Name:THOMPSON CARPENTER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:TALLEY
Other - Middle Name:DYAN
Other - Last Name:SURRETT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3657 CORTEZ RD W STE 110
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34210-3171
Mailing Address - Country:US
Mailing Address - Phone:941-474-2700
Mailing Address - Fax:941-474-8081
Practice Address - Street 1:2828 S MCCALL RD STE 25
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:FL
Practice Address - Zip Code:34224-9517
Practice Address - Country:US
Practice Address - Phone:941-474-2700
Practice Address - Fax:941-447-4808
Is Sole Proprietor?:No
Enumeration Date:2018-06-06
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT33359208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation