Provider Demographics
NPI:1508845819
Name:JELINEK, TOMAS (PT)
Entity Type:Individual
Prefix:MR
First Name:TOMAS
Middle Name:
Last Name:JELINEK
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 1:309 S ELK ST
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:MI
Mailing Address - Zip Code:48471
Mailing Address - Country:US
Mailing Address - Phone:810-648-9626
Mailing Address - Fax:810-648-9626
Practice Address - Street 1:309 S ELK ST
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:MI
Practice Address - Zip Code:48471
Practice Address - Country:US
Practice Address - Phone:810-648-9626
Practice Address - Fax:810-648-9626
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501004236225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4676225OtherAETNA
MI3182480Medicaid
MI4676225OtherAETNA
S07002Medicare UPIN
MI3182480Medicaid