Brian R Wally, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

011339 Issued in CT

Practice address

2520 Main St Ste 2
Glastonbury, CT 06033-4250

Phone

(860) 430-8383

Fax

(860) 856-6945

NPI assigned

Jun 9, 2016

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CT

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Focus Physical Therapy & Sports Medicine LLC

  • Physical Therapy Clinic/Center
  • Berlin, CT
  • NPI 1780868505

  Physical Therapist

  Medicare reassignment NPD
• Fox Rehab PT CT, LLC

  • Physical Therapist
  • Wilton, CT
  • NPI 1245584234
  Medicare reassignment NPD
• Ivyrehab Connecticut, Inc.

  • Physical Therapist
  • Old Greenwich, CT
  • NPI 1265799365
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1465430400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624320000000",
    "number": "1053760157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 417594",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022417594",
            "telephone_number": "914-294-4050",
            "fax_number": "207-799-9340"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2520 MAIN ST STE 2",
            "city": "GLASTONBURY",
            "state": "CT",
            "postal_code": "060334250",
            "telephone_number": "860-430-8383",
            "fax_number": "860-856-6945"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "94 Main St",
            "address_purpose": "LOCATION",
            "city": "Gorham",
            "state": "ME",
            "postal_code": "040381340",
            "country_code": "US",
            "telephone_number": "207-839-5860",
            "fax_number": "207-839-2499",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLY",
        "first_name": "BRIAN",
        "middle_name": "R",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-06-09",
        "last_updated": "2021-06-22",
        "certification_date": "2021-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "ME",
            "license": "PT4733",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CT",
            "license": "011339",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Walgreen Co (Walgreens# 02228)
• Walgreens Pharmacy
• Mary Jean Walker, APRN
• Brittany Bayne Wallace, CPNP
• Rachel Elyse Wallach, MD
• Dawn Walsh
• Jennifer Ashleigh Walsh
• Sara Jean Walsh, CDN
• Donna Ward, L.C.S.W.
• Sheryll Ann Waring, LPC LADC

• Physical Therapist in Glastonbury, CT
• Providers in Glastonbury, CT by specialty
• Physical Therapist in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.