MEDICARE: MRS. LEAH R BROWN PTA

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	225200000X	Physical Therapy Assistant		IL

General Provider Information

NPI Number	:	1851359970
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LEAH R BROWN PTA

Provider Business Mailing Address
First Line	:	1033 HELENE LN
Second Line	:
City	:	SCHAUMBURG
State	:	IL
Zip	:	60193-1328
Country	:	US
Telephone Number	:	312-493-5123
Fax Number	:

Provider Business Practice Location Address
First Line	:	1955 W NORTH AVE
Second Line	:
City	:	MELROSE PARK
State	:	IL
Zip	:	60160-1131
Country	:	US
Telephone Number	:	708-531-6101
Fax Number	:

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

Provider Enumeration Date	:	05/01/2006
Last Update Date	:	07/08/2007

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