MEDICARE: MRS. KEELY PETERSON BROWN PT

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	225100000X	Physical Therapist	P22144	NC

General Provider Information

NPI Number	:	1366877870
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KEELY PETERSON BROWN PT

Provider Business Mailing Address
First Line	:	107 TRITON LN
Second Line	:
City	:	SURF CITY
State	:	NC
Zip	:	28445-6923
Country	:	US
Telephone Number	:	910-803-2040
Fax Number	:	910-803-2050

Provider Business Practice Location Address
First Line	:	107 TRITON LN
Second Line	:
City	:	SURF CITY
State	:	NC
Zip	:	28445-6923
Country	:	US
Telephone Number	:	910-803-2040
Fax Number	:	910-803-2050

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

Provider Enumeration Date	:	09/04/2013
Last Update Date	:	04/16/2026

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