Provider Demographics
NPI:1225470750
Name:BROWN, SANDRA THOMAS (LMT)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:THOMAS
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 1:207 CENTER POINT RD
Mailing Address - Street 2:
Mailing Address - City:VICKSBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39183-9278
Mailing Address - Country:US
Mailing Address - Phone:601-218-2185
Mailing Address - Fax:601-634-0642
Practice Address - Street 1:1825 N FRONTAGE RD
Practice Address - Street 2:SUITE D
Practice Address - City:VICKSBURG
Practice Address - State:MS
Practice Address - Zip Code:39180-5178
Practice Address - Country:US
Practice Address - Phone:601-218-2185
Practice Address - Fax:601-634-0642
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-25
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1556225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist