Provider Demographics
NPI:1225220213
Name:BROWN, MARTY CATHERINE (DPT)
Entity Type:Individual
Prefix:
First Name:MARTY
Middle Name:CATHERINE
Last Name:BROWN
Suffix:
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 1:3512 SWEETGRASS CT
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-4244
Mailing Address - Country:US
Mailing Address - Phone:913-219-7928
Mailing Address - Fax:
Practice Address - Street 1:1198 FRONT ST
Practice Address - Street 2:
Practice Address - City:TONGANOXIE
Practice Address - State:KS
Practice Address - Zip Code:66086-9707
Practice Address - Country:US
Practice Address - Phone:913-845-2252
Practice Address - Fax:913-845-2262
Is Sole Proprietor?:No
Enumeration Date:2007-08-14
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1103726225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist