Provider Demographics
NPI:1144381591
Name:THOMAS, JOHN (RPT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:THOMAS
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21700 GREENFIELD RD
Mailing Address - Street 2:STE 123
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-2581
Mailing Address - Country:US
Mailing Address - Phone:248-761-9979
Mailing Address - Fax:586-806-1524
Practice Address - Street 1:21700 GREENFIELD RD
Practice Address - Street 2:STE 123
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-2581
Practice Address - Country:US
Practice Address - Phone:248-761-9979
Practice Address - Fax:586-806-1524
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501012836225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5501012836OtherPHYSICAL THERAPY LICENSE