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NPI Code Detail

MEDICARE: BRIAN VENGLAR PT, DPT

MEDICARE: BRIAN VENGLAR PT, DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist1211370TX
2225100000XPhysical Therapist5501015521MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
112274281OTHERCAQH

General Provider Information

NPI Number : 1013207711
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRIAN VENGLAR PT, DPT
Provider Business Mailing Address
First Line : 2558 N SQUIRREL RD
Second Line :
City : AUBURN HILLS
State : MI
Zip : 48326-2383
Country : US
Telephone Number : 248-340-1100
Fax Number : 248-340-1101
Provider Business Practice Location Address
First Line : 2558 N SQUIRREL RD
Second Line :
City : AUBURN HILLS
State : MI
Zip : 48326-2383
Country : US
Telephone Number : 248-340-1100
Fax Number : 248-340-1101
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/14/2011
Last Update Date : 01/07/2021

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