Provider Demographics
NPI:1699777367
Name:BROWN, ANGEL B (PT)
Entity type:Individual
Prefix:MRS
First Name:ANGEL
Middle Name:B
Last Name:BROWN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 ELMORE DR
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-2803
Mailing Address - Country:US
Mailing Address - Phone:478-971-4449
Mailing Address - Fax:
Practice Address - Street 1:117 ELMORE DR
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-2803
Practice Address - Country:US
Practice Address - Phone:478-971-4449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005299225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist