Basic Information
| Provider Information | |||||||||
| NPI: | 1265461875 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BROWN | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | RICHARD | ||||||||
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| Credential: | PT,SCS,ATC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 505 E MICHIGAN AVE | ||||||||
| Address2: | |||||||||
| City: | SALINE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481761588 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7349441005 | ||||||||
| FaxNumber: | 7349441303 | ||||||||
| Practice Location | |||||||||
| Address1: | 505 E MICHIGAN AVE | ||||||||
| Address2: | |||||||||
| City: | SALINE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481761588 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7349441005 | ||||||||
| FaxNumber: | 7349441303 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer | 2251S0007X | L717912 | MI | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Sports | 225100000X | 5501006126 | MI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.