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General NPI Number Information
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NPI Number | 1073005534
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Entity Type | Individual
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Provider Name | BRIAN WHALEN PT
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Gender | Male
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Dates
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Enumeration Date | 05/31/2018
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Last Update Date | 05/31/2018
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Provider Practice Location Address
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Address Line | 41632 ANN ARBOR RD E
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City | PLYMOUTH
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State | MI
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Zip | 48170-8006
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Country | US
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Telephone | 734-459-5171
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Fax |
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Provider Business Mailing Address
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Address Line | 26300 DARIA CIR W
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City | SOUTH LYON
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State | MI
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Zip | 48178-8088
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 5501007064
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License Number State | MI
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