Kenneth Wall
Individual provider Active NPI Physical Therapist · Durand, MI
NPI 1710475397 · NPPES record last updated Apr 29, 2018
Key facts
- NPI
- 1710475397
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 5501017586 (MI)
- Practice address
- 8750 Monroe Rd
Durand, MI 48429-1000 - Phone
- (989) 288-3166
- NPI assigned
- Apr 29, 2018
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5501017586 | MI | MD | Physical Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 5501017586 | MI | Yes |
Addresses
Primary practice location
8750 Monroe Rd
Durand, MI 48429-1000
Mailing address
8353 Apple Blossom LN
Flushing, MI 48433-1192
Phone (810) 252-1798
Other practice location 1
427 E Washington St
Saint Louis, MI 48880-1980
Phone (989) 681-5721
Other providers in Durand, MI
- James Dewey Stephens
- Emma Grace Storm
- Cole Szakal
- Tender Care Home Health Care LLC
- Brandi Tew
- Kimberly Jun Webster
- Kristi Kay White
- Jean Rose Witt-Rowley
All providers in Durand, MI · Physical Therapist in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 29, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.