Provider Demographics
NPI:1235177064
Name:BROWN, CARROLL E (PT)
Entity Type:Individual
Prefix:
First Name:CARROLL
Middle Name:E
Last Name:BROWN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2122 YORK RD STE 300
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1925
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:130A JAMES OTIS SMITH DR
Practice Address - Street 2:
Practice Address - City:WALNUT
Practice Address - State:MS
Practice Address - Zip Code:38683
Practice Address - Country:US
Practice Address - Phone:662-223-0064
Practice Address - Fax:662-223-0074
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT549225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist