MEDICARE: REID LARSON WALLEMAN 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
1	225100000X	Physical Therapist	5501304335	MI

General Provider Information

NPI Number	:	1477482123
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REID LARSON WALLEMAN PT, DPT

Provider Business Mailing Address
First Line	:	6591 W CENTRAL AVE STE 105
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43617-1097
Country	:	US
Telephone Number	:	419-843-6002
Fax Number	:

Provider Business Practice Location Address
First Line	:	6700 WESTSIDE SAGINAW RD
Second Line	:
City	:	BAY CITY
State	:	MI
Zip	:	48706-9325
Country	:	US
Telephone Number	:	989-667-9800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2026
Last Update Date	:	05/18/2026

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