Provider Demographics
NPI:1124321351
Name:BROWN, LAURIE ANNE (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:ANNE
Last Name:BROWN
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 W SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:SAULT SAINTE MARIE
Mailing Address - State:MI
Mailing Address - Zip Code:49783-1912
Mailing Address - Country:US
Mailing Address - Phone:906-635-5100
Mailing Address - Fax:906-635-1143
Practice Address - Street 1:146 W SPRUCE ST
Practice Address - Street 2:
Practice Address - City:SAULT SAINTE MARIE
Practice Address - State:MI
Practice Address - Zip Code:49783-1912
Practice Address - Country:US
Practice Address - Phone:906-635-5100
Practice Address - Fax:906-635-1143
Is Sole Proprietor?:No
Enumeration Date:2010-12-09
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501011158225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist