Provider Demographics
| NPI: | 1922607183 |
|---|---|
| Name: | MCCARROLL, BRIAN GLENN (DPT) |
| Entity Type: | Individual |
| Prefix: | DR |
| First Name: | BRIAN |
| Middle Name: | GLENN |
| Last Name: | MCCARROLL |
| Suffix: | |
| Gender: | M |
| 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: | 7605 FLICKINGER DR |
| Mailing Address - Street 2: | |
| Mailing Address - City: | SHELBY TOWNSHIP |
| Mailing Address - State: | MI |
| Mailing Address - Zip Code: | 48317-2337 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 586-733-0561 |
| Mailing Address - Fax: | |
| Practice Address - Street 1: | 14626 23 MILE RD |
| Practice Address - Street 2: | |
| Practice Address - City: | SHELBY TOWNSHIP |
| Practice Address - State: | MI |
| Practice Address - Zip Code: | 48315-3000 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 586-733-0561 |
| Practice Address - Fax: | |
| Is Sole Proprietor?: | Yes |
| Enumeration Date: | 2020-10-20 |
| Last Update Date: | 2020-10-20 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| MI | 5501019674 | 2251E1200X, 2251E1300X, 2251G0304X, 2251H1300X, 2251N0400X, 2251P0200X, 2251S0007X, 2251X0800X, 225100000X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Single Specialty | |
| No | 2251E1200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Ergonomics | Group - Single Specialty |
| No | 2251E1300X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Electrophysiology, Clinical | |
| No | 2251G0304X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Geriatrics | |
| No | 2251H1300X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Human Factors | |
| No | 2251N0400X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Neurology | |
| No | 2251P0200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Pediatrics | |
| No | 2251S0007X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Sports | |
| No | 2251X0800X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic |
