| Brandon Wallace, PT | |
|
29900 Southfield Rd, Southfield, MI 48076-2090 | |
| (248) 663-0400 | |
| (248) 621-5003 |
| Full Name | Brandon Wallace |
|---|---|
| Gender | Male |
| Speciality | Physical Therapy |
| Experience | 7 Years |
| Location | 29900 Southfield Rd, Southfield, Michigan |
| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700395274 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 225100000X | Physical Therapist | 5501018432 (Michigan) | Primary |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Cks Of Mt Clemens Llc | 0446321038 | 19 |
| Provider Name | Kss Of Shelby Llc |
|---|---|
| Provider Type | Part B Supplier - Physical/occupational Therapy Group In Private Practice |
| Provider Identifiers | NPI Number: 1770788739 PECOS PAC ID: 9335218619 Enrollment ID: O20080625000057 |
| Provider Name | Cks Of Mt Clemens Llc |
|---|---|
| Provider Type | Part B Supplier - Physical/occupational Therapy Group In Private Practice |
| Provider Identifiers | NPI Number: 1619172673 PECOS PAC ID: 0446321038 Enrollment ID: O20080626000011 |
| Provider Name | Vms Of Macomb Twp Llc |
|---|---|
| Provider Type | Part B Supplier - Clinic/group Practice |
| Provider Identifiers | NPI Number: 1750527438 PECOS PAC ID: 7012072952 Enrollment ID: O20090210000390 |
| Provider Name | Michigan Rehabilitation Specialists Of Fowlerville Llc |
|---|---|
| Provider Type | Part B Supplier - Physical/occupational Therapy Group In Private Practice |
| Provider Identifiers | NPI Number: 1669531166 PECOS PAC ID: 6204730393 Enrollment ID: O20130927000721 |
| Mailing Address | Practice Location Address |
|---|---|
| Brandon Wallace, PT 790 Remington Blvd, Bolingbrook, IL 60440-4909 Ph: () - | Brandon Wallace, PT 29900 Southfield Rd, Southfield, MI 48076-2090 Ph: (248) 663-0400 |
Ashtiaq Khokhar, Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 23999 Northwestern Hwy, Southfield, MI 48075 Phone: 248-304-1100 | |
Thomas Chung, DPT Physical Therapist Medicare: Medicare Enrolled Practice Location: 26025 Lahser Rd, Southfield, MI 48033 Phone: 248-663-1910 Fax: 248-849-0190 | |
Briana Keller, DPT Physical Therapist Medicare: Accepting Medicare Assignments Practice Location: 23800 W 10 Mile Rd Ste 193, Southfield, MI 48033 Phone: 248-827-1100 Fax: 248-827-1120 | |
Paige Robinson, DPT Physical Therapist Medicare: Medicare Enrolled Practice Location: 23800 W 10 Mile Rd Ste 193, Southfield, MI 48033 Phone: 248-827-1100 Fax: 248-827-1120 | |
Toms K Mathew, RPT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 28309 Franklin Rd, Southfield, MI 48034 Phone: 248-208-6100 Fax: 248-208-6119 | |
Jaspal Kaur, Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 24681 Northwestern Hwy, Sut 103, Southfield, MI 48075 Phone: 248-809-9360 | |
Lahser Medical Campus Physical Therapy Llc Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 27207 Lahser Rd Ste 106, Southfield, MI 48034 Phone: 248-948-9448 |