Provider Demographics
NPI:1639121130
Name:BROWN, CLARICE MAE (PT)
Entity Type:Individual
Prefix:MS
First Name:CLARICE
Middle Name:MAE
Last Name:BROWN
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 1:3420 PINERIDGE LN
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-7405
Mailing Address - Country:US
Mailing Address - Phone:810-229-7211
Mailing Address - Fax:
Practice Address - Street 1:7743 GRAND RIVER RD
Practice Address - Street 2:#100
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48114-7393
Practice Address - Country:US
Practice Address - Phone:810-227-3588
Practice Address - Fax:810-227-4993
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501000560225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI236642Medicare ID - Type Unspecified