Provider Demographics
NPI:1821078445
Name:PLUSZCZYK, TOMASZ R (PT)
Entity Type:Individual
Prefix:
First Name:TOMASZ
Middle Name:R
Last Name:PLUSZCZYK
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 1:7650 DIXIE HWY
Mailing Address - Street 2:SUITE 140
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-2078
Mailing Address - Country:US
Mailing Address - Phone:248-620-9310
Mailing Address - Fax:248-922-5945
Practice Address - Street 1:7650 DIXIE HWY
Practice Address - Street 2:SUITE 140
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-2078
Practice Address - Country:US
Practice Address - Phone:248-922-5617
Practice Address - Fax:248-922-5945
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501007831225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N37000Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
MIN37000010Medicare ID - Type Unspecified