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General NPI Number Information
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NPI Number | 1225470750
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Entity Type | Individual
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Provider Name | SANDRA THOMAS BROWN LMT
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Gender | Female
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Dates
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Enumeration Date | 07/25/2013
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Last Update Date | 09/04/2013
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Provider Practice Location Address
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Address Line | 1825 N FRONTAGE RD SUITE D
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City | VICKSBURG
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State | MS
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Zip | 39180-5178
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Country | US
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Telephone | 601-218-2185
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Fax | 601-634-0642
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Provider Business Mailing Address
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Address Line | 207 CENTER POINT RD
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City | VICKSBURG
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State | MS
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Zip | 39183-9278
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Country | US
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Telephone | 601-218-2185
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Fax | 601-634-0642
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 1556
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License Number State | MS
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