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NPI Code Detail

MEDICARE: TOMIKA WILEY MPT

MEDICARE: TOMIKA WILEY MPT
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
1225100000XPhysical Therapist5501009254MI

General Provider Information

NPI Number : 1588941132
Entity Type Code : Individual
Provider Name (Legal Business Name) : TOMIKA WILEY MPT
Provider Business Mailing Address
First Line : 6208 CROOKED RIVER DR
Second Line :
City : SWARTZ CREEK
State : MI
Zip : 48473-8979
Country : US
Telephone Number : 810-265-5268
Fax Number :
Provider Business Practice Location Address
First Line : 303 E KEARSLEY ST
Second Line :
City : FLINT
State : MI
Zip : 48502-1907
Country : US
Telephone Number : 810-424-5269
Fax Number : 810-424-5288
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/10/2011
Last Update Date : 10/04/2013

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Directions to “ TOMIKA WILEY MPT” Practice Location

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