Healthcare Provider Details

I. General information

NPI: 1548845407
Provider Name (Legal Business Name): BROOKE NICOLE BROWN DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2021
Last Update Date: 03/12/2021
Certification Date: 03/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 JACKSON AVE
AUSTIN TX
78731-6056
US

IV. Provider business mailing address

9308 S 1ST ST APT 1516
AUSTIN TX
78748-0017
US

V. Phone/Fax

Practice location:
  • Phone: 512-454-4711
  • Fax:
Mailing address:
  • Phone: 615-506-8920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number1342933
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: