Basic Information
| Provider Information | |||||||||
| NPI: | 1679053235 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CASE | ||||||||
| FirstName: | BROOKE | ||||||||
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| OtherLastName: | LEHMAN | ||||||||
| OtherFirstName: | BROOKE | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 4761 LAKE MICHIGAN DR NW | ||||||||
| Address2: | SUITE A | ||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495346300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2317374374 | ||||||||
| FaxNumber: | 2318309196 | ||||||||
| Practice Location | |||||||||
| Address1: | 721 THREE MILE RD NW | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495448230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6166088933 | ||||||||
| FaxNumber: | 2318309196 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/14/2018 | ||||||||
| LastUpdateDate: | 09/09/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 5501018783 | MI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.