Provider Demographics
NPI:1588916167
Name:BROWN, MARY-MARGARET (PTA)
Entity type:Individual
Prefix:
First Name:MARY-MARGARET
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 1:3266 SHEPARD RD
Mailing Address - Street 2:
Mailing Address - City:FREEDOM
Mailing Address - State:IN
Mailing Address - Zip Code:47431-7271
Mailing Address - Country:US
Mailing Address - Phone:812-606-0244
Mailing Address - Fax:
Practice Address - Street 1:303 N. HURSRTBOURNE PARKWAY
Practice Address - Street 2:SUITE 200
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222
Practice Address - Country:US
Practice Address - Phone:502-412-5847
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-08
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06000528A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant