Provider Demographics
NPI:1538126479
Name:BRAZIE, KAREN SUE (PT)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:SUE
Last Name:BRAZIE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 YANKEE PARK PL
Mailing Address - Street 2:STE A
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45458-1838
Mailing Address - Country:US
Mailing Address - Phone:937-439-4949
Mailing Address - Fax:937-439-4948
Practice Address - Street 1:1550 YANKEE PARK PL
Practice Address - Street 2:STE A
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45458-1838
Practice Address - Country:US
Practice Address - Phone:937-439-4949
Practice Address - Fax:937-439-4948
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT-02000208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2511393Medicaid
OHBR4141192Medicare PIN
OH2511393Medicaid