Healthcare Provider Details

I. General information

NPI: 1477482123
Provider Name (Legal Business Name): REID LARSON WALLEMAN PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6700 WESTSIDE SAGINAW RD
BAY CITY MI
48706-9325
US

IV. Provider business mailing address

804 N WATER ST
BAY CITY MI
48708-5620
US

V. Phone/Fax

Practice location:
  • Phone: 989-667-9800
  • Fax:
Mailing address:
  • Phone: 989-573-8266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501304335
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: