Provider Demographics
NPI:1093216269
Name:TOMASIC, JODY (PT)
Entity Type:Individual
Prefix:
First Name:JODY
Middle Name:
Last Name:TOMASIC
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40245 GRAND RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-2119
Mailing Address - Country:US
Mailing Address - Phone:248-473-5600
Mailing Address - Fax:
Practice Address - Street 1:40245 GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-2119
Practice Address - Country:US
Practice Address - Phone:248-473-5600
Practice Address - Fax:248-473-8480
Is Sole Proprietor?:No
Enumeration Date:2018-02-23
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501002365225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist