Provider Demographics
NPI:1093960874
Name:THOMAS, TESNA MARY (RPT)
Entity Type:Individual
Prefix:MRS
First Name:TESNA
Middle Name:MARY
Last Name:THOMAS
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:TESNA
Other - Middle Name:M
Other - Last Name:MATHEW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18645 CLOVER HILL CT
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48168
Mailing Address - Country:US
Mailing Address - Phone:248-346-2425
Mailing Address - Fax:
Practice Address - Street 1:36975 5 MILE RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-1871
Practice Address - Country:US
Practice Address - Phone:248-346-2425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-20
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501008595261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy