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General NPI Number Information
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NPI Number | 1366802720
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Entity Type | Individual
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Provider Name | MARY BROWN
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Gender | Female
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Dates
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Enumeration Date | 02/29/2016
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Last Update Date | 02/29/2016
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Provider Practice Location Address
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Address Line | 1909 N 2ND ST
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City | CABOT
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State | AR
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Zip | 72023-2209
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Country | US
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Telephone | 501-843-7157
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Fax | 501-843-4617
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Provider Business Mailing Address
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Address Line | 21 SAGEBRUSH LN
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City | CABOT
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State | AR
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Zip | 72023-8187
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Country | US
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Telephone | 662-523-0517
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Fax |
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA 3968
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License Number State | AR
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