| Organization Name: | THUNDER BAY THERAPY & SPORTS MEDICINE |
| NPI Number: | 1003203605 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KRISTINE ERNST (OCCUPATIONAL THERAPIST) |
| Mailing Address: | 348 Long Rapids Plz Alpena |
| State: | MI US |
| Postal Code: | 497071374 |
| Phone Number: | 9893588086 |
| Fax Number: | 9893542253 |
| NPI Enumeration Date: | 04/21/2015 |
| NPI Last Update Date: | 04/21/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QX0100X |
| License Number: | 5201009050 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Occupational Medicine |
| Taxonomy Definition: | |