Provider Demographics
NPI:1952087496
Name:BRAIN MEETS BRAWN LLC
Entity Type:Organization
Organization Name:BRAIN MEETS BRAWN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER & ATHLETIC TRAINER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GORNEY
Authorized Official - Suffix:
Authorized Official - Credentials:AT
Authorized Official - Phone:586-808-8282
Mailing Address - Street 1:2698 WINTER DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-5735
Mailing Address - Country:US
Mailing Address - Phone:586-808-8282
Mailing Address - Fax:
Practice Address - Street 1:3029 HILTON RD
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:MI
Practice Address - Zip Code:48220-1070
Practice Address - Country:US
Practice Address - Phone:586-808-8282
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-27
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation