| Doctor Name: | MR. BENJAMIN JOHN WALLIS |
| NPI Number: | 1871554899 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MSPT |
| License Number: | 1585173 |
| Business Practice Address: | 39885 Grand River Ste 300 Novi, MI - 48375 |
| Business Phone Number: | 2486150282 |
| Business Fax Number: | 2486150415 |
| Mailing Address: | 39885 Grand River, Ste 300 NOVI |
| State: | MI |
| Postal Code: | 48375 |
| Phone Number: | 2486150282 |
| Fax Number: | 2486150415 |
| NPI Enumeration Date: | 03/29/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 1585173 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |