Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 5501019674 | MI |
N | 2251E1200X | Ergonomics | 5501019674 | MI |
N | 225XE1200X | Ergonomics | 5501019674 | MI |
N | 2251E1300X | Electrophysiology, Clinical | 5501019674 | MI |
N | 2251G0304X | Physical Therapist - Geriatrics | 5501019674 | MI |
N | 2251H1300X | Human Factors | 5501019674 | MI |
N | 225XH1300X | Human Factors | 5501019674 | MI |
N | 2251N0400X | Physical Therapist - Neurology | 5501019674 | MI |
N | 2251P0200X | Physical Therapist - Pediatrics | 5501019674 | MI |
N | 2251S0007X | Physical Therapist - Sports | 5501019674 | MI |
N | 2251X0800X | Physical Therapist - Orthopedic | 5501019674 | MI |
NPI | 1922607183 |
---|---|
Provider Name | Dr. Brian Glenn Mccarroll |
First Address | Shelby Township, MI 48317-2337 |
Second Address | Shelby Township, MI 48315-3000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2020 |
Last Update Date | 20/10/2020 |