Provider Demographics
NPI:1285169326
Name:BROWN, JOANNA (PTA)
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 TIMBER CV
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-6824
Mailing Address - Country:US
Mailing Address - Phone:571-208-3099
Mailing Address - Fax:443-569-7464
Practice Address - Street 1:959 RIVER STRAND LOOP
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7800
Practice Address - Country:US
Practice Address - Phone:571-208-3099
Practice Address - Fax:443-569-7464
Is Sole Proprietor?:No
Enumeration Date:2017-04-26
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA2008225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant