Active NPI
Thomas Hadley Gustafson, DPT
- Physical Therapist
- Niles, MI
National Provider Identifier
1407105612
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 5501016024
- Practice address
- 20 N 2ND St
Suite 3
Niles, MI 49120-2259 - Phone
- (269) 687-9594
- Fax
- (269) 687-9543
- NPI assigned
- Sep 4, 2012
- Last updated
- Sep 4, 2012
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 5501016024 | MI | Primary |
Addresses
Primary practice location
20 N 2ND St
Suite 3
Niles, MI 49120-2259
Mailing address
20 N 2ND St
Suite 3
Niles, MI 49120-2259
Phone (269) 687-9594
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- HHS exclusion list flag
- CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found.
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dery Rehabilitation Services, PC | Past | Accepting new patients | |
| Life in Balance Inc | Physical Therapist | Past | Accepting new patients |
| Life in Balance LLC | Physical Therapist | Past | Accepting new patients |
| Life in Balance, LLC | Physical Therapist | Past | Accepting new patients |
Organizations & group practices 5
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Physical Therapy Clinic/Center
- Grand Rapids, MI
- NPI 1902288863
-
- Physical Therapy Clinic/Center
- Lowell, MI
- NPI 1366588196
-
- Physical Therapist
- Niles, MI
- NPI 1417056318
-
- Physical Therapist
- Mishawaka, IN
- NPI 1730297177
-
- Physical Therapist
- South Bend, IN
- NPI 1790098879
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1346716800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1346716800000",
"number": "1407105612",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "20 N 2ND ST",
"address_2": "SUITE 3",
"city": "NILES",
"state": "MI",
"postal_code": "491202259",
"telephone_number": "269-687-9594",
"fax_number": "269-687-9543"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "20 N 2ND ST",
"address_2": "SUITE 3",
"city": "NILES",
"state": "MI",
"postal_code": "491202259",
"telephone_number": "269-687-9594",
"fax_number": "269-687-9543"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GUSTAFSON",
"first_name": "THOMAS",
"middle_name": "HADLEY",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-09-04",
"last_updated": "2012-09-04",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MI",
"license": "5501016024",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Niles, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.