Basic Information
| Provider Information | |||||||||
| NPI: | 1437312410 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BROWN | ||||||||
| FirstName: | ANGIE | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 135 GOSHEN ROAD EXT | ||||||||
| Address2: | STE 206 | ||||||||
| City: | RINCON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 313265567 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9128263797 | ||||||||
| FaxNumber: | 9128269767 | ||||||||
| Practice Location | |||||||||
| Address1: | 135 GOSHEN ROAD EXT | ||||||||
| Address2: | STE 206 | ||||||||
| City: | RINCON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 313265567 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9128263797 | ||||||||
| FaxNumber: | 9128269767 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2008 | ||||||||
| LastUpdateDate: | 07/09/2008 | ||||||||
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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 | 225100000X | PT009049 | GA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.