Provider Demographics
NPI:1083242267
Name:UBYSZ, TOMASZ (PT)
Entity Type:Individual
Prefix:
First Name:TOMASZ
Middle Name:
Last Name:UBYSZ
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6848 KINGSLAND
Mailing Address - Street 2:
Mailing Address - City:SHELBY TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48317-6312
Mailing Address - Country:US
Mailing Address - Phone:586-707-9007
Mailing Address - Fax:
Practice Address - Street 1:6848 KINGSLAND
Practice Address - Street 2:
Practice Address - City:SHELBY TWP
Practice Address - State:MI
Practice Address - Zip Code:48317-6312
Practice Address - Country:US
Practice Address - Phone:586-707-9007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-01
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501008838225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist