Provider Demographics
NPI:1811063019
Name:BROWN, JOSEPH CHADWICK (PT)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:CHADWICK
Last Name:BROWN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:MR
Other - First Name:CHAD
Other - Middle Name:
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:206B OXFORD RD
Mailing Address - Street 2:PO BOX 44
Mailing Address - City:NEW ALBANY
Mailing Address - State:MS
Mailing Address - Zip Code:38652-3115
Mailing Address - Country:US
Mailing Address - Phone:662-534-4445
Mailing Address - Fax:662-534-9449
Practice Address - Street 1:206B OXFORD RD
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:MS
Practice Address - Zip Code:38652-3115
Practice Address - Country:US
Practice Address - Phone:662-534-4445
Practice Address - Fax:662-534-9449
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT3035225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS582681044OtherTAX ID #
MS06538835Medicaid
MS06538835Medicaid