Provider Demographics
NPI:1316357361
Name:BROWN, AMBRA (DPT)
Entity Type:Individual
Prefix:
First Name:AMBRA
Middle Name:
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 1:1918 WILTSHIRE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-1080
Mailing Address - Country:US
Mailing Address - Phone:615-513-1362
Mailing Address - Fax:
Practice Address - Street 1:555 BRADBURN VILLAGE CIR
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:TN
Practice Address - Zip Code:37013-1991
Practice Address - Country:US
Practice Address - Phone:615-513-1362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-29
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8044225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist