Healthcare Provider Details

I. General information

NPI: 1396890885
Provider Name (Legal Business Name): ANGIE DEANNA BROWN CHAMBERS MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANGIE CHAMBERS P.T.

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 05/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3584 SPRINGHURST BLVD
LOUISVILLE KY
40241-4141
US

IV. Provider business mailing address

1415 AARON CREEK DR
FISHERVILLE KY
40023-7780
US

V. Phone/Fax

Practice location:
  • Phone: 502-339-4700
  • Fax:
Mailing address:
  • Phone: 502-777-3255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number004026
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: