Provider Demographics
NPI:1083339865
Name:BROWN, ROBERT (LMT)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:BROWN
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21351 GENTRY DR STE 114
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20166-8510
Mailing Address - Country:US
Mailing Address - Phone:703-982-0006
Mailing Address - Fax:
Practice Address - Street 1:21351 GENTRY DR STE 114
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20166-8510
Practice Address - Country:US
Practice Address - Phone:703-982-0006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-05
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019011185225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0019011185OtherVIRGINIA NURSING BOARD