Healthcare Provider Details

I. General information

NPI: 1245822824
Provider Name (Legal Business Name): STACY LYNN HULSEY-BROWN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: STACY LYNN BROWN PT

II. Dates (important events)

Enumeration Date: 02/05/2021
Last Update Date: 06/17/2021
Certification Date: 06/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4025 WOODLAND PARK BLVD STE 120
ARLINGTON TX
76013-4301
US

IV. Provider business mailing address

4025 WOODLAND PARK BLVD STE 120
ARLINGTON TX
76013-4301
US

V. Phone/Fax

Practice location:
  • Phone: 817-792-2030
  • Fax: 817-792-2031
Mailing address:
  • Phone: 817-792-2030
  • Fax: 817-792-2031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number1116895
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: