Healthcare Provider Details

I. General information

NPI: 1841691748
Provider Name (Legal Business Name): THOMAS SMITH PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2014
Last Update Date: 11/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1422 N MONROE ST
MONROE MI
48162-4211
US

IV. Provider business mailing address

1422 N MONROE ST
MONROE MI
48162-4211
US

V. Phone/Fax

Practice location:
  • Phone: 734-243-0300
  • Fax: 734-243-3066
Mailing address:
  • Phone: 734-243-0300
  • Fax: 734-243-3066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501010555
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: