MEDICARE: BRIAN VASICEK DPT PLLC

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
1	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1831702414
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIAN VASICEK DPT PLLC

Provider Business Mailing Address
First Line	:	3207 N ALTADENA AVE
Second Line	:
City	:	ROYAL OAK
State	:	MI
Zip	:	48073-3557
Country	:	US
Telephone Number	:	248-709-7336
Fax Number	:

Provider Business Practice Location Address
First Line	:	743 S BYWOOD AVE
Second Line	:
City	:	CLAWSON
State	:	MI
Zip	:	48017-1851
Country	:	US
Telephone Number	:	248-709-7336
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. BRIAN VASICEK
Credential	:	PHYSICAL THERAPIST
Telephone Number	:	248-709-7336

Provider Enumeration Date	:	08/25/2020
Last Update Date	:	01/22/2025

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