Provider Demographics
NPI:1114203122
Name:BROWN, AMY BASIS (MSPT)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:BASIS
Last Name:BROWN
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 ORCHARD LN
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-3625
Mailing Address - Country:US
Mailing Address - Phone:860-983-9039
Mailing Address - Fax:
Practice Address - Street 1:22 ORCHARD LN
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-3625
Practice Address - Country:US
Practice Address - Phone:860-983-9039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-24
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT005217225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist