MEDICARE: THUMB PHYSICAL MEDICINE & REHAB

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM2500X	Medical Specialty Clinic/Center	4301091071	MI

General Provider Information

NPI Number	:	1104129303
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THUMB PHYSICAL MEDICINE & REHAB

Provider Business Mailing Address
First Line	:	1117 S VAN DYKE RD
Second Line	:	SUITE 100
City	:	BAD AXE
State	:	MI
Zip	:	48413-8467
Country	:	US
Telephone Number	:	989-269-7252
Fax Number	:	989-269-7304

Provider Business Practice Location Address
First Line	:	1117 S VAN DYKE RD
Second Line	:	SUITE 100
City	:	BAD AXE
State	:	MI
Zip	:	48413-8467
Country	:	US
Telephone Number	:	989-269-7252
Fax Number	:	989-269-7304

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. JOEL DE GUZMAN
Credential	:	M.D.
Telephone Number	:	989-269-7252

Provider Enumeration Date	:	12/09/2010
Last Update Date	:	03/31/2011

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