Provider Demographics
NPI:1982245726
Name:THAKORE, MICHAEL C (DPT)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:C
Last Name:THAKORE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 TANAGER LN
Mailing Address - Street 2:
Mailing Address - City:CRANBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08512-2122
Mailing Address - Country:US
Mailing Address - Phone:201-230-5837
Mailing Address - Fax:
Practice Address - Street 1:220 CENTENNIAL AVE
Practice Address - Street 2:
Practice Address - City:PISCATAWAY
Practice Address - State:NJ
Practice Address - Zip Code:08854-3940
Practice Address - Country:US
Practice Address - Phone:732-980-6235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-02
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01879000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist