Provider Demographics
NPI:1730397217
Name:BROWN, ANTHONY GILBERT (NCMMT)
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:GILBERT
Last Name:BROWN
Suffix:
Gender:M
Credentials:NCMMT
Other - Prefix:MRS
Other - First Name:MARSHELL
Other - Middle Name:
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:1850 BACK HAMPDEN SYDNEY RD
Mailing Address - Street 2:
Mailing Address - City:FARMVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23901-5500
Mailing Address - Country:US
Mailing Address - Phone:434-392-1448
Mailing Address - Fax:
Practice Address - Street 1:1850 BACK HAMPDEN SYDNEY RD
Practice Address - Street 2:
Practice Address - City:FARMVILLE
Practice Address - State:VA
Practice Address - Zip Code:23901-5500
Practice Address - Country:US
Practice Address - Phone:434-391-3663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA00019 000422225700000X
VA44241-00225700000X
VA2306000387225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant