Healthcare Provider Details

I. General information

NPI: 1013986553
Provider Name (Legal Business Name): STANLEY LEE BROWN PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 01/11/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

902 W BATTLEFIELD ST
SPRINGFIELD MO
65807-4130
US

IV. Provider business mailing address

5490 S AARON AVE
SPRINGFIELD MO
65810-2034
US

V. Phone/Fax

Practice location:
  • Phone: 417-886-6200
  • Fax: 417-886-6201
Mailing address:
  • Phone: 417-886-6200
  • Fax: 417-886-6201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberR0660
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: