| Doctor Name: | MR. MICHAEL ROBERT THEEMAN |
| NPI Number: | 1841401296 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MSPT |
| License Number: | 025807-1 |
| Business Practice Address: | 75 Park Street Elizabethtown, NY - 12932 |
| Business Phone Number: | 5188736377 |
| Business Fax Number: | 5188732005 |
| Mailing Address: | 44 Elm St Apt 3, PLATTSBURGH |
| State: | NY |
| Postal Code: | 129011828 |
| Phone Number: | 5185697591 |
| Fax Number: | |
| NPI Enumeration Date: | 05/25/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 025807-1 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |