Provider Demographics
NPI:1174704217
Name:BROWN, SHELLEY DENEEN (PTA)
Entity type:Individual
Prefix:MISS
First Name:SHELLEY
Middle Name:DENEEN
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 1:6802 MAPLE LEAF CT
Mailing Address - Street 2:APT 102
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-1861
Mailing Address - Country:US
Mailing Address - Phone:443-352-8186
Mailing Address - Fax:
Practice Address - Street 1:6802 MAPLE LEAF CT
Practice Address - Street 2:APT 102
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-1861
Practice Address - Country:US
Practice Address - Phone:443-352-8186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-16
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA3141225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant