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General NPI Number Information
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NPI Number | 1932298643
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Entity Type | Individual
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Provider Name | THOMAS SYRIAC PT
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Gender | Male
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Dates
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Enumeration Date | 10/12/2006
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Last Update Date | 05/02/2019
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Provider Practice Location Address
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Address Line | 40200 GRAND RIVER AVE STE 400
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City | NOVI
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State | MI
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Zip | 48375-2146
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Country | US
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Telephone | 248-987-2855
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Fax | 248-957-6713
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Provider Business Mailing Address
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Address Line | 23989 WESTMONT DR
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City | NOVI
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State | MI
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Zip | 48374-3658
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 5501009312
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 5501009312
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License Number State | MI
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