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NPI Code Detail

MEDICARE: DR. BRETT AUSTIN BIRNBAUM PT, DPT

MEDICARE: DR. BRETT AUSTIN BIRNBAUM 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
1225100000XPhysical Therapist5501020138MI

General Provider Information

NPI Number : 1285304295
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BRETT AUSTIN BIRNBAUM PT, DPT
Provider Business Mailing Address
First Line : 522 E BRECKENRIDGE ST
Second Line :
City : FERNDALE
State : MI
Zip : 48220-1324
Country : US
Telephone Number : 734-772-1064
Fax Number :
Provider Business Practice Location Address
First Line : 2705 ORCHARD LAKE RD
Second Line :
City : KEEGO HARBOR
State : MI
Zip : 48320-1446
Country : US
Telephone Number : 734-772-1064
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2021
Last Update Date : 09/20/2021

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