Provider Demographics
NPI:1992108260
Name:BROWN, HALEY MARIE (LPTA)
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:MARIE
Last Name:BROWN
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3718 BRIGHTON PL
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:AR
Mailing Address - Zip Code:72936-6850
Mailing Address - Country:US
Mailing Address - Phone:479-206-3797
Mailing Address - Fax:
Practice Address - Street 1:3718 BRIGHTON PL
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:AR
Practice Address - Zip Code:72936-6850
Practice Address - Country:US
Practice Address - Phone:479-206-3797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-01
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPTA 3839225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1992108260Medicaid