Provider Demographics
NPI:1164588216
Name:BROWN, GEORGIA LYN I (DPT)
Entity Type:Individual
Prefix:
First Name:GEORGIA
Middle Name:LYN
Last Name:BROWN
Suffix:I
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4631 HANSEN RD
Mailing Address - Street 2:
Mailing Address - City:LOOMIS
Mailing Address - State:CA
Mailing Address - Zip Code:95650-9318
Mailing Address - Country:US
Mailing Address - Phone:916-652-7347
Mailing Address - Fax:916-652-7077
Practice Address - Street 1:9267 GREENBACK LN
Practice Address - Street 2:
Practice Address - City:ORANGEVALE
Practice Address - State:CA
Practice Address - Zip Code:95662-4863
Practice Address - Country:US
Practice Address - Phone:916-205-5521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25519225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist