Provider Demographics
NPI:1104129303
Name:THUMB PHYSICAL MEDICINE & REHAB
Entity type:Organization
Organization Name:THUMB PHYSICAL MEDICINE & REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DE GUZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:989-269-7252
Mailing Address - Street 1:1117 S VAN DYKE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BAD AXE
Mailing Address - State:MI
Mailing Address - Zip Code:48413-8467
Mailing Address - Country:US
Mailing Address - Phone:989-269-7252
Mailing Address - Fax:989-269-7304
Practice Address - Street 1:1117 S VAN DYKE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:BAD AXE
Practice Address - State:MI
Practice Address - Zip Code:48413-8467
Practice Address - Country:US
Practice Address - Phone:989-269-7252
Practice Address - Fax:989-269-7304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-09
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301091071261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty