Provider Demographics
NPI:1083998595
Name:BROWN, CHRISTA MARIE (PT)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTA
Middle Name:MARIE
Last Name:BROWN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1909 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:CABOT
Mailing Address - State:AR
Mailing Address - Zip Code:72023-2209
Mailing Address - Country:US
Mailing Address - Phone:501-843-7157
Mailing Address - Fax:501-843-4617
Practice Address - Street 1:1909 N 2ND ST
Practice Address - Street 2:
Practice Address - City:CABOT
Practice Address - State:AR
Practice Address - Zip Code:72023-2209
Practice Address - Country:US
Practice Address - Phone:501-843-7157
Practice Address - Fax:501-843-4617
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-03
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT 3407174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist