Healthcare Provider Details

I. General information

NPI: 1457757098
Provider Name (Legal Business Name): ANGELA BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2014
Last Update Date: 05/07/2024
Certification Date: 05/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N CENTRAL AVE STE 110
KISSIMMEE FL
34741-4439
US

IV. Provider business mailing address

797 TEAGUE TRL APT 11204
LADY LAKE FL
32159-3150
US

V. Phone/Fax

Practice location:
  • Phone: 407-530-5063
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA 20458
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: