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NPI Code Detail

MEDICARE: MS. BLAIRE BROERS BROWN DPT

MEDICARE:  MS. BLAIRE BROERS BROWN  DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12251X0800XOrthopedic Physical Therapist070016918IL

General Provider Information

NPI Number : 1083936256
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. BLAIRE BROERS BROWN DPT
Provider Business Mailing Address
First Line : 2929 N SOUTHPORT AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60657-6945
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2929 N SOUTHPORT AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60657-6945
Country : US
Telephone Number : 773-665-9947
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/16/2010
Last Update Date : 10/30/2013

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Directions to “ MS. BLAIRE BROERS BROWN DPT” Practice Location

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