MEDICARE: AMY BROWN

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	PT 2701	AR

General Provider Information

NPI Number	:	1700867090
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY BROWN

Provider Business Mailing Address
First Line	:	PO BOX 13765
Second Line	:
City	:	MAUMELLE
State	:	AR
Zip	:	72113-0765
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10301 N RODNEY PARHAM RD
Second Line	:	B-1
City	:	LITTLE ROCK
State	:	AR
Zip	:	72227-4832
Country	:	US
Telephone Number	:	501-604-5600
Fax Number	:

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

Provider Enumeration Date	:	11/14/2005
Last Update Date	:	07/08/2007

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