Healthcare Provider Details

I. General information

NPI: 1700868601
Provider Name (Legal Business Name): LINDA J BROWN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 S CREEK DR SUITE 116
MONTICELLO KY
42633-9472
US

IV. Provider business mailing address

1 S CREEK DR SUITE 116
MONTICELLO KY
42633-9472
US

V. Phone/Fax

Practice location:
  • Phone: 606-348-3314
  • Fax: 606-348-3315
Mailing address:
  • Phone: 606-348-3314
  • Fax: 606-348-3315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number000547
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: