Provider Demographics
NPI:1902885619
Name:BROWN, MICHAEL R (PT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:R
Last Name:BROWN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2147 W 12 ST
Mailing Address - Street 2:STE 1
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505-4835
Mailing Address - Country:US
Mailing Address - Phone:814-456-6000
Mailing Address - Fax:814-456-6060
Practice Address - Street 1:2147 W 12 ST
Practice Address - Street 2:STE 1
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16505-4835
Practice Address - Country:US
Practice Address - Phone:814-456-6000
Practice Address - Fax:814-456-6060
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT-016821-L225100000X
PAPT0106821225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1009979400008Medicaid
PA001611417OtherBS
PA1009979400008Medicaid