Provider Demographics
NPI:1871833582
Name:THOMAS, LANCE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:LANCE
Middle Name:
Last Name:THOMAS
Suffix:
Gender:M
Credentials:PT, DPT
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
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-4258
Mailing Address - Country:US
Mailing Address - Phone:586-416-9103
Mailing Address - Fax:
Practice Address - Street 1:27555 FARMINGTON RD
Practice Address - Street 2:SUITE 140
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-3376
Practice Address - Country:US
Practice Address - Phone:248-516-1300
Practice Address - Fax:248-516-1301
Is Sole Proprietor?:No
Enumeration Date:2013-02-18
Last Update Date:2016-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501016210225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist