Healthcare Provider Details

I. General information

NPI: 1255100368
Provider Name (Legal Business Name): BRANDON HUANG PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2023
Last Update Date: 12/29/2023
Certification Date: 12/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3420 WEST RD
TRENTON MI
48183-2323
US

IV. Provider business mailing address

429 W MAPLEDALE AVE
HAZEL PARK MI
48030-1024
US

V. Phone/Fax

Practice location:
  • Phone: 734-671-1923
  • Fax:
Mailing address:
  • Phone: 734-972-3812
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501303070
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: