Provider Demographics
NPI:1821149527
Name:THOMAS, SURESH ZACHARIAH (PT)
Entity Type:Individual
Prefix:MR
First Name:SURESH
Middle Name:ZACHARIAH
Last Name:THOMAS
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 1:51577 MERRY LN
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48316-3860
Mailing Address - Country:US
Mailing Address - Phone:586-726-9374
Mailing Address - Fax:586-726-9374
Practice Address - Street 1:51577 MERRY LN
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48316-3860
Practice Address - Country:US
Practice Address - Phone:586-726-9374
Practice Address - Fax:586-726-9374
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501010148225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist