Individual
BRIAN R WALLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
2520 MAIN ST STE 2, GLASTONBURY, CT 06033-4250
(860) 430-8383
(860) 856-6945
Mailing address
PO BOX 417594, BOSTON, MA 02241-7594
(914) 294-4050
(207) 799-9340
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
011339
CT
225100000X
Physical Therapist
PT4733
ME
Other
Enumeration date
06/09/2016
Last updated
06/22/2021
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