Healthcare Provider Details

I. General information

NPI: 1578474383
Provider Name (Legal Business Name): MR. TERRELL BROWN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 BROWN ST UNIT B
HEALDSBURG CA
95448-3710
US

IV. Provider business mailing address

611 BROWN ST UNIT B
HEALDSBURG CA
95448-3710
US

V. Phone/Fax

Practice location:
  • Phone: 402-686-5913
  • Fax:
Mailing address:
  • Phone: 402-686-5913
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: