Provider Demographics
NPI:1225332513
Name:BROWN, WENDY LYNNE (LMT)
Entity Type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:LYNNE
Last Name:BROWN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2024 LEANDRA LN
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76131-1247
Mailing Address - Country:US
Mailing Address - Phone:682-433-2089
Mailing Address - Fax:
Practice Address - Street 1:2024 LEANDRA LN
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76131-1247
Practice Address - Country:US
Practice Address - Phone:682-433-2089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-01
Last Update Date:2011-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT100335225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist