Provider Demographics
NPI:1932298643
Name:SYRIAC, THOMAS (PT)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:
Last Name:SYRIAC
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 1:23989 WESTMONT DR
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48374-3658
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:40200 GRAND RIVER AVE STE 400
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-2146
Practice Address - Country:US
Practice Address - Phone:248-987-2855
Practice Address - Fax:248-957-6713
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501009312208100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1952498180OtherTYPE 2 NPI OF ALTERNATIVE REHAB INC
MI1831461201OtherTYPE 2 NPI OF INSPIRATIONS REHAB