Provider Demographics
NPI:1497031629
Name:MACBETH, ALAINA BROWN (DPT)
Entity Type:Individual
Prefix:
First Name:ALAINA
Middle Name:BROWN
Last Name:MACBETH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ALAINA
Other - Middle Name:NICOLE
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:3381 HIDDEN OAKS LN
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48324-3256
Mailing Address - Country:US
Mailing Address - Phone:248-891-3085
Mailing Address - Fax:248-779-7543
Practice Address - Street 1:6018 W MAPLE RD
Practice Address - Street 2:SUITE 850
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-4404
Practice Address - Country:US
Practice Address - Phone:248-932-0111
Practice Address - Fax:248-932-0110
Is Sole Proprietor?:No
Enumeration Date:2011-11-02
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501015697225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP36520017OtherMEDICARE PTAN