Provider Demographics
NPI:1295005700
Name:BROWN, LAURIE MARIE (PTA)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:MARIE
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 1:410 E MILLER AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78363-6332
Mailing Address - Country:US
Mailing Address - Phone:619-804-5426
Mailing Address - Fax:
Practice Address - Street 1:410 E MILLER AVE
Practice Address - Street 2:
Practice Address - City:KINGSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78363-6332
Practice Address - Country:US
Practice Address - Phone:619-804-5426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-01
Last Update Date:2012-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2078932225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant