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General NPI Number Information
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NPI Number | 1407310394
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Entity Type | Individual
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Provider Name | BRYAN ANTHONY FORTON
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Gender | Male
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Dates
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Enumeration Date | 01/25/2019
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Last Update Date | 07/08/2025
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Provider Practice Location Address
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Address Line | 52461 BUTTERNUT DR
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City | SHELBY TOWNSHIP
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State | MI
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Zip | 48316-2947
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Country | US
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Telephone | 248-266-5721
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 80143
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City | ROCHESTER
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State | MI
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Zip | 48308-0143
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Country | US
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Telephone | 586-295-3383
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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 | 5501019050
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License Number State | MI
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