Brandon Wallace, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

5501018432 Issued in MI

Practice address

29900 Southfield Rd
Southfield, MI 48076-2090

Phone

(248) 663-0400

Fax

(248) 621-5003

NPI assigned

Sep 27, 2017

Last updated

Sep 27, 2017By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

CKS of Mt Clemens LLCGroup PAC ID 0446321038, 17 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

75.73 of 100Reported as group

Quality

81.02

Improvement activities

40

Cost

53.9

Medicare enrollment (NPD)

Enrolled

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• CKS of Mt Clemens LLC

  dba Healthquest Physical Therapy & Wellness

  • Physical Therapy Clinic/Center
  • Mount Clemens, MI
  • NPI 1619172673

  Physical Therapist

  Medicare reassignment Care Compare group NPD
• KSS of Shelby LLC

  dba Healthquest Physical Therapy & Wellness

  • Physical Therapy Clinic/Center
  • Shelby Township, MI
  • NPI 1770788739

  Physical Therapist

  Medicare reassignment NPD
• Michigan Rehabilitation Specialists of Fowlerville LLC

  dba ATI Physical Therapy

  • Physical Therapist
  • Fowlerville, MI
  • NPI 1669531166
  Medicare reassignment NPD
• VMS of Macomb TWP LLC

  dba Healthquest Physical Therapy

  • Physical Therapy Clinic/Center
  • Macomb, MI
  • NPI 1750527438
  Medicare reassignment NPD
• KSS of Shelby LLC

  • Durable Medical Equipment & Medical Supplies
  • Shelby TWP, MI
  • NPI 1902769029
  NPD
• Michigan Rehabilitation Specialists of Fowlerville, LLC

  • Durable Medical Equipment & Medical Supplies
  • Dexter, MI
  • NPI 1407525892
  NPD
• Trishard P.C.

  dba Michigan Therapy Institute

  • Rehabilitation Clinic/Center
  • Warren, MI
  • NPI 1992793442
  NPD (past)

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

{
    "created_epoch": "1506470400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1506470400000",
    "number": "1700395274",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "790 REMINGTON BLVD",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604404909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29900 SOUTHFIELD RD",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480762090",
            "telephone_number": "248-663-0400",
            "fax_number": "248-621-5003"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "BRANDON",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-09-27",
        "last_updated": "2017-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MI",
            "license": "5501018432",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sharron Denise Walker, PH.D
• Tanya Marie Walker, M.S., LLP
• Tara L Walker, DNP, APRN, ACNP-BC
• Victoria Walker, PCD
• Wallace & Associates
• Felicia Marie Wallace, FNP-BC
• Tiffany Brandice Wallace
• Caiden James Walter, DO
• Charlene Walton Windham
• Terrie Walton-Banks

• Physical Therapist in Southfield, MI
• Providers in Southfield, MI by specialty
• Physical Therapist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.