Provider Demographics
NPI:1265461875
Name:BROWN, STEPHEN RICHARD (PT,SCS,ATC)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:RICHARD
Last Name:BROWN
Suffix:
Gender:M
Credentials:PT,SCS,ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 E MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:SALINE
Mailing Address - State:MI
Mailing Address - Zip Code:48176-1588
Mailing Address - Country:US
Mailing Address - Phone:734-944-1005
Mailing Address - Fax:734-944-1303
Practice Address - Street 1:505 E MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:SALINE
Practice Address - State:MI
Practice Address - Zip Code:48176-1588
Practice Address - Country:US
Practice Address - Phone:734-944-1005
Practice Address - Fax:734-944-1303
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X
MIL7179122251S0007X
MI5501006126225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports