MEDICARE: ELLEN BRAUSE PT

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
1	225100000X	Physical Therapist	2021006180	MO
2	225100000X	Physical Therapist	2021004304	MO

General Provider Information

NPI Number	:	1598357402
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELLEN BRAUSE PT

Provider Business Mailing Address
First Line	:	607 DEWEY AVE NW STE 300
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49504-5283
Country	:	US
Telephone Number	:	616-356-5000
Fax Number	:	616-356-5001

Provider Business Practice Location Address
First Line	:	1982 1ST CAPITOL DR
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63301-1609
Country	:	US
Telephone Number	:	636-949-3926
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/11/2021
Last Update Date	:	12/21/2025

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