Provider Demographics
NPI:1033657390
Name:THOMAS, MARISSA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 FULTON ST E
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-5917
Mailing Address - Country:US
Mailing Address - Phone:810-923-7924
Mailing Address - Fax:
Practice Address - Street 1:2425 W WASHINGTON ST STE B
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MI
Practice Address - Zip Code:48838-8259
Practice Address - Country:US
Practice Address - Phone:616-225-2325
Practice Address - Fax:616-225-2366
Is Sole Proprietor?:No
Enumeration Date:2017-02-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501017856208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation