Healthcare Provider Details

I. General information

NPI: 1235461856
Provider Name (Legal Business Name): DEANNE BROWN PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2010
Last Update Date: 02/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 W 31ST ST
CHICAGO IL
60616-3116
US

IV. Provider business mailing address

3018 N HOYNE AVE
CHICAGO IL
60618-8290
US

V. Phone/Fax

Practice location:
  • Phone: 312-225-3119
  • Fax:
Mailing address:
  • Phone: 312-485-3742
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number160005296
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: