Healthcare Provider Details

I. General information

NPI: 1457272007
Provider Name (Legal Business Name): ELIJAH BROWN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8554 US HIGHWAY 51 UNIT 6/7
MINOCQUA WI
54548-9312
US

IV. Provider business mailing address

8554 US HIGHWAY 51 UNIT 6/7
MINOCQUA WI
54548-9312
US

V. Phone/Fax

Practice location:
  • Phone: 715-358-1929
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number3323
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: