Provider Demographics
NPI:1093115651
Name:BROWN, CHRISTIE (PTA)
Entity Type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:238 WOODS FARM RD
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:VT
Mailing Address - Zip Code:05855-8930
Mailing Address - Country:US
Mailing Address - Phone:802-334-5838
Mailing Address - Fax:
Practice Address - Street 1:238 WOODS FARM RD
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:VT
Practice Address - Zip Code:05855-8930
Practice Address - Country:US
Practice Address - Phone:802-334-5838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-01
Last Update Date:2014-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH041.0000521261Q00000X, 282N00000X, 314000000X
VT041/0000521261Q00000X
VT041.0000521310400000X, 311Z00000X, 313M00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No282N00000XHospitalsGeneral Acute Care Hospital
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility