Provider Demographics
NPI:1588842322
Name:COLT, THOMAS WHITFIELD (PT, ATC)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:WHITFIELD
Last Name:COLT
Suffix:
Gender:M
Credentials:PT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33900 HARPER AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-4258
Mailing Address - Country:US
Mailing Address - Phone:586-350-2644
Mailing Address - Fax:586-541-3735
Practice Address - Street 1:525 N MAIN ST STE 120
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MI
Practice Address - Zip Code:48381-1592
Practice Address - Country:US
Practice Address - Phone:248-329-3700
Practice Address - Fax:248-329-3881
Is Sole Proprietor?:No
Enumeration Date:2008-02-04
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501017239225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ395241Medicaid
AZ7941OtherLICENSE #
AZ395241Medicaid