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General NPI Number Information
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NPI Number | 1386699031
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Entity Type | Organization
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Legal Business Name | THUNDER BAY THERAPY & SPORTS MEDICINE, PLC
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Dates
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Enumeration Date | 05/23/2006
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Last Update Date | 12/04/2007
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Provider Practice Location Address
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Address Line | 348 LONG RAPIDS PLZ
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City | ALPENA
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State | MI
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Zip | 49707-1374
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Country | US
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Telephone | 989-358-8086
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Fax | 989-354-2253
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Provider Business Mailing Address
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Address Line | 348 LONG RAPIDS PLZ
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City | ALPENA
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State | MI
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Zip | 49707-1374
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Country | US
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Telephone | 989-358-8086
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Fax | 989-354-2253
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Authorized Official
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Title or Position | CLINIC ADMINISTRATOR
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Name | MRS. TERESA LYNN DUNCAN
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Credential | PHYSCIAL THERAPIST
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Telephone | 989-358-8086
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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