Provider Demographics
NPI:1033381728
Name:THUMB PHYSIATRY PC
Entity Type:Organization
Organization Name:THUMB PHYSIATRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICK
Authorized Official - Middle Name:J
Authorized Official - Last Name:REINA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-985-1608
Mailing Address - Street 1:2603 ELECTRIC AVE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-6588
Mailing Address - Country:US
Mailing Address - Phone:810-985-1608
Mailing Address - Fax:810-987-3011
Practice Address - Street 1:2603 ELECTRIC AVE
Practice Address - Street 2:SUITE 6
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-6588
Practice Address - Country:US
Practice Address - Phone:810-985-1608
Practice Address - Fax:810-987-3011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-02
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1966810Medicaid
MI1966810Medicaid