Provider Demographics
NPI:1699556514
Name:LAGUE, BRENT (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:BRENT
Middle Name:
Last Name:LAGUE
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:BRENT
Other - Middle Name:
Other - Last Name:LAGUE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:590 PIT RD
Mailing Address - Street 2:
Mailing Address - City:BROWNSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:46112-7830
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:590 PIT RD
Practice Address - Street 2:
Practice Address - City:BROWNSBURG
Practice Address - State:IN
Practice Address - Zip Code:46112-7830
Practice Address - Country:US
Practice Address - Phone:317-415-6040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-06
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16449-24225100000X
IN05015153A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist