Healthcare Provider Details

I. General information

NPI: 1801020045
Provider Name (Legal Business Name): PULIANTHURUTHIL JOSEPH THOMAS NCTM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: P J THOMAS NCTM

II. Dates (important events)

Enumeration Date: 05/02/2009
Last Update Date: 06/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22548-RAMBLING DRIVE
MACOMB MI
48044-3739
US

IV. Provider business mailing address

22548-RAMBLING DRIVE
MACOMB MI
48044-3739
US

V. Phone/Fax

Practice location:
  • Phone: 586-468-0312
  • Fax: 586-468-0312
Mailing address:
  • Phone: 586-468-0312
  • Fax: 586-468-0312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code173C00000X
TaxonomyReflexologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: