Healthcare Provider Details

I. General information

NPI: 1023314705
Provider Name (Legal Business Name): REGEANIA BROWN LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2011
Last Update Date: 10/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5610 CRAWFORDSVILLE RD SUITE 1101
INDIANAPOLIS IN
46224-3727
US

IV. Provider business mailing address

5610 CRAWFORDSVILLE RD SUITE 1101
INDIANAPOLIS IN
46224-3727
US

V. Phone/Fax

Practice location:
  • Phone: 317-987-2009
  • Fax:
Mailing address:
  • Phone: 317-987-2009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT20902844
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: