Provider Demographics
NPI:1407298516
Name:PETERSEN-BRAND, DEBORAH KAY
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:KAY
Last Name:PETERSEN-BRAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31815 SOUTHFIELD RD
Mailing Address - Street 2:STE. 17
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-5471
Mailing Address - Country:US
Mailing Address - Phone:248-631-6403
Mailing Address - Fax:248-593-3181
Practice Address - Street 1:31815 SOUTHFIELD RD
Practice Address - Street 2:STE. 17
Practice Address - City:BEVERLY HILLS
Practice Address - State:MI
Practice Address - Zip Code:48025-5471
Practice Address - Country:US
Practice Address - Phone:248-631-6403
Practice Address - Fax:248-593-3181
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-18
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL2420352172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist