MEDICARE: GENICE BROWN

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	R00626	MD

General Provider Information

NPI Number	:	1780129593
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GENICE BROWN

Provider Business Mailing Address
First Line	:	8086 MAIN ST
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21043-4617
Country	:	US
Telephone Number	:	410-480-5101
Fax Number	:	410-465-3571

Provider Business Practice Location Address
First Line	:	8086 MAIN ST
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21043-4617
Country	:	US
Telephone Number	:	410-480-5101
Fax Number	:	410-465-3571

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

Provider Enumeration Date	:	01/03/2017
Last Update Date	:	01/03/2017

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Directions to “ GENICE BROWN ” Practice Location

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