Healthcare Provider Details

I. General information

NPI: 1508227596
Provider Name (Legal Business Name): ALLISON MARY BROWN ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2016
Last Update Date: 03/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1017 S FAIR OAKS AVE
PASADENA CA
91105-2621
US

IV. Provider business mailing address

334 ROBINSON ST
LOS ANGELES CA
90026-4537
US

V. Phone/Fax

Practice location:
  • Phone: 304-668-5774
  • Fax:
Mailing address:
  • Phone: 304-668-5774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2000008587
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: