MEDICARE: MR. THOMAS SYRIAC PT

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	208100000X	Physical Medicine & Rehabilitation Physician	5501009312	MI
2	225100000X	Physical Therapist	5501009312	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1952498180	OTHER	MI	TYPE 2 NPI OF ALTERNATIVE REHAB INC
2	1831461201	OTHER	MI	TYPE 2 NPI OF INSPIRATIONS REHAB

General Provider Information

NPI Number	:	1932298643
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. THOMAS SYRIAC PT

Provider Business Mailing Address
First Line	:	23989 WESTMONT DR
Second Line	:
City	:	NOVI
State	:	MI
Zip	:	48374-3658
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	40200 GRAND RIVER AVE STE 400
Second Line	:
City	:	NOVI
State	:	MI
Zip	:	48375-2146
Country	:	US
Telephone Number	:	248-987-2855
Fax Number	:	248-957-6713

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

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	05/02/2019

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Directions to “ MR. THOMAS SYRIAC PT” Practice Location

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