Provider Demographics
NPI:1194337774
Name:BROWN, MAIREAD (DPT)
Entity type:Individual
Prefix:
First Name:MAIREAD
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 DIAMOND CREEK PL
Mailing Address - Street 2:UNIT 125
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95747-7188
Mailing Address - Country:US
Mailing Address - Phone:916-457-8802
Mailing Address - Fax:
Practice Address - Street 1:3400 ELVAS AVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95819-1913
Practice Address - Country:US
Practice Address - Phone:916-457-8802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-17
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA298685208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA298685OtherPT LICENSE