Active NPI
Brandon Comerford
- Physical Therapy Assistant
- Detroit, MI
National Provider Identifier
1629823000
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 5502003250
- Practice address
- 2567 W Grand Blvd
Detroit, MI 48208-1235 - Phone
- (313) 895-5340
- NPI assigned
- Apr 19, 2024
- Last updated
- Apr 19, 2024
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 5502003250 | MI | Primary |
Addresses
Primary practice location
2567 W Grand Blvd
Detroit, MI 48208-1235
Mailing address
1106 Woodside Trail Dr
Troy, MI 48085-1317
Phone (248) 863-6235
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5502003250 | MI | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1713484800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1713484800000",
"number": "1629823000",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1106 WOODSIDE TRAIL DR",
"city": "TROY",
"state": "MI",
"postal_code": "480851317",
"telephone_number": "248-863-6235"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2567 W GRAND BLVD",
"city": "DETROIT",
"state": "MI",
"postal_code": "482081235",
"telephone_number": "313-895-5340"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COMERFORD",
"first_name": "BRANDON",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-04-19",
"last_updated": "2024-04-19",
"certification_date": "2024-04-19",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "MI",
"license": "5502003250",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Detroit, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.