Healthcare Provider Details

I. General information

NPI: 1457760787
Provider Name (Legal Business Name): MICHELLE K BROWN DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE K JOHNSON

II. Dates (important events)

Enumeration Date: 08/12/2014
Last Update Date: 01/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 N MAIN ST
NOBLE OK
73068-9322
US

IV. Provider business mailing address

440 MERCHANT DR
NORMAN OK
73069-6470
US

V. Phone/Fax

Practice location:
  • Phone: 405-809-8700
  • Fax: 405-872-5901
Mailing address:
  • Phone: 405-809-8713
  • Fax: 405-573-6768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4862
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: