Healthcare Provider Details

I. General information

NPI: 1730397217
Provider Name (Legal Business Name): ANTHONY GILBERT BROWN NCMMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MARSHELL BROWN RN

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 08/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 BACK HAMPDEN SYDNEY RD
FARMVILLE VA
23901-5500
US

IV. Provider business mailing address

1850 BACK HAMPDEN SYDNEY RD
FARMVILLE VA
23901-5500
US

V. Phone/Fax

Practice location:
  • Phone: 434-391-3663
  • Fax:
Mailing address:
  • Phone: 434-392-1448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2306000387
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number00019 000422
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number44241-00
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: