Provider Demographics
NPI:1871749416
Name:THOMPSON, REUBEN BRYN (FCAMT, BSCPT)
Entity type:Individual
Prefix:MR
First Name:REUBEN
Middle Name:BRYN
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:FCAMT, BSCPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2396 KEYSTONE CT
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-1936
Mailing Address - Country:US
Mailing Address - Phone:303-449-4316
Mailing Address - Fax:
Practice Address - Street 1:2400 SPRUCE ST
Practice Address - Street 2:SUITE 101
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-4617
Practice Address - Country:US
Practice Address - Phone:303-440-3359
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-14
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO96842251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic