MEDICARE: STACY M BROWN LMT

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	225700000X	Massage Therapist	MT133516	TX

General Provider Information

NPI Number	:	1346816915
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACY M BROWN LMT

Provider Business Mailing Address
First Line	:	2259 MILLSTONE DR UNIT A
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77073-1561
Country	:	US
Telephone Number	:	832-510-5160
Fax Number	:

Provider Business Practice Location Address
First Line	:	17907 KUYKENDAHL RD STE 302
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77379-8152
Country	:	US
Telephone Number	:	832-510-5160
Fax Number	:

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

Provider Enumeration Date	:	06/03/2021
Last Update Date	:	06/03/2021

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