Healthcare Provider Details

I. General information

NPI: 1508845819
Provider Name (Legal Business Name): TOMAS JELINEK PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2006
Last Update Date: 07/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 S ELK ST
SANDUSKY MI
48471
US

IV. Provider business mailing address

309 S ELK ST
SANDUSKY MI
48471
US

V. Phone/Fax

Practice location:
  • Phone: 810-648-9626
  • Fax: 810-648-9626
Mailing address:
  • Phone: 810-648-9626
  • Fax: 810-648-9626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501004236
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: