Individual
BRIAN CLARK BOESE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
10415 GRAND RIVER RD STE 300, BRIGHTON, MI 48116-6533
(810) 229-6140
(810) 229-6145
Mailing address
790 REMINGTON BLVD, BOLINGBROOK, IL 60440-4909
(810) 229-6140
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
004883
IA
225100000X
Physical Therapist
Primary
5501018260
MI
225100000X
Physical Therapist
60259
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0349714
WA L&I
OR
05
—
500697800
—
OR
01
—
P01740336
RR MEDICARE
OR
Enumeration date
02/08/2012
Last updated
03/17/2018
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