Healthcare Provider Details

I. General information

NPI: 1598357402
Provider Name (Legal Business Name): ELLEN BRAUSE PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2021
Last Update Date: 12/21/2025
Certification Date: 12/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1982 1ST CAPITOL DR
SAINT CHARLES MO
63301-1609
US

IV. Provider business mailing address

607 DEWEY AVE NW STE 300
GRAND RAPIDS MI
49504-5283
US

V. Phone/Fax

Practice location:
  • Phone: 636-949-3926
  • Fax:
Mailing address:
  • Phone: 616-356-5000
  • Fax: 616-356-5001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2021006180
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2021004304
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: