Provider Demographics
NPI:1003193095
Name:BROWN, VICKIE DIANE (CRT)
Entity Type:Individual
Prefix:MRS
First Name:VICKIE
Middle Name:DIANE
Last Name:BROWN
Suffix:
Gender:F
Credentials:CRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 REHWINKEL RD
Mailing Address - Street 2:
Mailing Address - City:CRAWFORDVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32327
Mailing Address - Country:US
Mailing Address - Phone:850-926-8209
Mailing Address - Fax:
Practice Address - Street 1:320 REHWINKEL RD
Practice Address - Street 2:
Practice Address - City:CRAWFORDVILLE
Practice Address - State:FL
Practice Address - Zip Code:32327-3316
Practice Address - Country:US
Practice Address - Phone:850-926-8209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-04
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTT8487227800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Certified