Provider Demographics
NPI:1013207711
Name:VENGLAR, BRIAN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:VENGLAR
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2558 N SQUIRREL RD
Mailing Address - Street 2:
Mailing Address - City:AUBURN HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48326-2383
Mailing Address - Country:US
Mailing Address - Phone:248-340-1100
Mailing Address - Fax:248-340-1101
Practice Address - Street 1:2558 N SQUIRREL RD
Practice Address - Street 2:
Practice Address - City:AUBURN HILLS
Practice Address - State:MI
Practice Address - Zip Code:48326-2383
Practice Address - Country:US
Practice Address - Phone:248-340-1100
Practice Address - Fax:248-340-1101
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-14
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1211370225100000X
MI5501015521225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
12274281OtherCAQH