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1700395274
BRANDON WALLACE
SOUTHFIELD, MI
NPI
1700395274
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
225100000X Physical Therapist
(Licence: MI 5501018432)
Enumeration Date
2017-09-27
Last Update Date
2017-09-27
Business Address
BRANDON WALLACE PT
29900 SOUTHFIELD RD
SOUTHFIELD, MI 48076-2090
Phone number: 248-663-0400
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Mailing Address
BRANDON WALLACE PT
790 REMINGTON BLVD
BOLINGBROOK, IL 60440-4909
Phone number:
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