Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Brian R Wally, DPT

Individual provider Physical Therapist · NPI 1053760157

Brian R Wally, DPT is a Physical Therapist in Glastonbury, Connecticut. Works from 2 locations. Licensed in Connecticut and Maine.

Licensed in
CT, ME
In the registry since
2016
Specialties on file
2
What do these letters mean?
DPT — Doctor of Physical Therapy
The doctoral degree now required to enter physical therapy practice.

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Practice location Address checks out

2520 Main St Ste 2
Glastonbury, CT 06033-4250
Phone: (860) 430-8383
Fax: (860) 856-6945
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 94 Main St, Gorham, ME 04038-1340 — (207) 839-5860

Specialties & licences

Physical Therapist (primary) Taxonomy 225100000X · Licence 011339 (CT)
Physical Therapist Taxonomy 225100000X · Licence PT4733 (ME)

Record details

NPI number1053760157
Entity typeIndividual (Type 1)
GenderMale
Credentials DPT
Sole proprietorNo
NPI enumeratedJune 9, 2016
Last updated in NPPESJune 22, 2021
Certification dateJune 22, 2021
Mailing addressPo Box 417594, Boston, MA 02241-7594

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