Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 5501015595 | MI |
N | 2251G0304X | Physical Therapist - Geriatrics | 5501015955 | MI |
N | 2251S0007X | Physical Therapist - Sports | 5501015595 | MI |
Y | 2251X0800X | Physical Therapist - Orthopedic | 5501015955 | MI |
NPI | 1356682587 |
---|---|
Provider Name | Mr. Ashish Thomas |
First Address | Troy, MI 48099-9705 |
Second Address | Flint, MI 48532-3560 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/03/2013 |
Last Update Date | 13/03/2013 |