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NPI Code Detail

MEDICARE: BRANDON WALBERT DPT

MEDICARE: BRANDON WALBERT 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 Therapist004545WV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1004545OTHERWVBOARD OF PHYSICAL THERAPY LICENSE

General Provider Information

NPI Number : 1346978129
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRANDON WALBERT DPT
Provider Business Mailing Address
First Line : 414 PENCO RD
Second Line :
City : WEIRTON
State : WV
Zip : 26062-3822
Country : US
Telephone Number : 304-723-3780
Fax Number : 304-723-4110
Provider Business Practice Location Address
First Line : 414 PENCO RD
Second Line :
City : WEIRTON
State : WV
Zip : 26062-3822
Country : US
Telephone Number : 304-723-3780
Fax Number : 304-723-4110
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/10/2022
Last Update Date : 08/10/2022

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Directions to “ BRANDON WALBERT DPT” Practice Location

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