Healthcare Provider Details

I. General information

NPI: 1568789683
Provider Name (Legal Business Name): LAURA MARIE BROWN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURA MARIE HAKMAN PT

II. Dates (important events)

Enumeration Date: 04/29/2010
Last Update Date: 07/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 N MAPLE ST
EFFINGHAM IL
62401
US

IV. Provider business mailing address

503 N MAPLE ST
EFFINGHAM IL
62401
US

V. Phone/Fax

Practice location:
  • Phone: 217-347-1243
  • Fax: 217-347-1558
Mailing address:
  • Phone: 217-347-1243
  • Fax: 217-347-1558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070005685
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: