MEDICARE: THOMAS MICHAELS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	40QA00913700	NJ

General Provider Information

NPI Number	:	1417046897
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS MICHAELS

Provider Business Mailing Address
First Line	:	160 WAVE RD
Second Line	:
City	:	MANAHAWKIN
State	:	NJ
Zip	:	08050-1714
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	890 W BAY AVE
Second Line	:	STE A
City	:	BARNEGAT
State	:	NJ
Zip	:	08005-2150
Country	:	US
Telephone Number	:	609-698-1073
Fax Number	:	866-842-7430

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	07/20/2016

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Directions to “ THOMAS MICHAELS ” Practice Location

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