Provider Demographics
NPI:1902096225
Name:BROWN, MICHAEL V (PT)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:V
Last Name:BROWN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:1700 TOWER DR W
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-7511
Mailing Address - Country:US
Mailing Address - Phone:651-275-4706
Mailing Address - Fax:
Practice Address - Street 1:433 MENDOTA RD E
Practice Address - Street 2:
Practice Address - City:WEST ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55118-5104
Practice Address - Country:US
Practice Address - Phone:651-552-5928
Practice Address - Fax:651-450-2211
Is Sole Proprietor?:No
Enumeration Date:2007-08-01
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7956225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN650001852Medicare PIN