Basic Information
| Provider Information | |||||||||
| NPI: | 1427166578 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BROWN | ||||||||
| FirstName: | HEATHER | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | P.T.A., A.T.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8519 49TH ST W | ||||||||
| Address2: | |||||||||
| City: | UNIVERSITY PLACE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984671809 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5623551596 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7308 BRIDGEPORT WAY W | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | LAKEWOOD | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984998000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2535828142 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2006 | ||||||||
| LastUpdateDate: | 01/28/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | P1 60033055 | WA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant | 2255A2300X | A1 60030256 | WA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.