MEDICARE: DORIS BROWN PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	A1452	MD

General Provider Information

NPI Number	:	1336485473
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DORIS BROWN PTA

Provider Business Mailing Address
First Line	:	1498 REISTERSTOWN ROAD #248
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21208
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1498 REISTERSTOWN RD # 248
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21208-3817
Country	:	US
Telephone Number	:	410-637-7370
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/18/2012
Last Update Date	:	12/18/2012

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Directions to “ DORIS BROWN PTA” Practice Location

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