Healthcare Provider Details

I. General information

NPI: 1386699031
Provider Name (Legal Business Name): THUNDER BAY THERAPY & SPORTS MEDICINE, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 12/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

348 LONG RAPIDS PLZ
ALPENA MI
49707-1374
US

IV. Provider business mailing address

348 LONG RAPIDS PLZ
ALPENA MI
49707-1374
US

V. Phone/Fax

Practice location:
  • Phone: 989-358-8086
  • Fax: 989-354-2253
Mailing address:
  • Phone: 989-358-8086
  • Fax: 989-354-2253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. TERESA LYNN DUNCAN
Title or Position: CLINIC ADMINISTRATOR
Credential: PHYSCIAL THERAPIST
Phone: 989-358-8086