Provider Demographics
NPI:1760667471
Name:MILLER-WILKS, BRANDY LYNN (DPT)
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:LYNN
Last Name:MILLER-WILKS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50920 VAN DYKE AVE
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48317-1367
Mailing Address - Country:US
Mailing Address - Phone:586-330-0872
Mailing Address - Fax:866-630-0604
Practice Address - Street 1:50920 VAN DYKE AVE
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48317-1367
Practice Address - Country:US
Practice Address - Phone:586-330-0872
Practice Address - Fax:866-630-0604
Is Sole Proprietor?:No
Enumeration Date:2008-01-02
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK18762251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics