Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 5501006126 | MI |
N | 2251S0007X | Physical Therapist - Sports | L717912 | MI |
NPI | 1265461875 |
---|---|
Provider Name | Stephen Richard Brown |
First Address | Saline, MI 48176-1588 |
Second Address | Saline, MI 48176-1588 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2006 |
Last Update Date | 17/03/2018 |