Provider Demographics
NPI:1043470891
Name:THOMSON'S PHYSICAL THERAPY
Entity type:Organization
Organization Name:THOMSON'S PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:NICHELLE
Authorized Official - Last Name:KOENIGSHOF
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:269-687-9110
Mailing Address - Street 1:333 N 2ND ST
Mailing Address - Street 2:SUITE 308
Mailing Address - City:NILES
Mailing Address - State:MI
Mailing Address - Zip Code:49120-2258
Mailing Address - Country:US
Mailing Address - Phone:269-687-9110
Mailing Address - Fax:269-687-9120
Practice Address - Street 1:333 N 2ND ST
Practice Address - Street 2:SUITE 308
Practice Address - City:NILES
Practice Address - State:MI
Practice Address - Zip Code:49120-2258
Practice Address - Country:US
Practice Address - Phone:269-687-9110
Practice Address - Fax:269-687-9120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-16
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501011329261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy