Provider Demographics
NPI:1336297456
Name:BROWN, ALLEN MICHAEL (MPT, MBA)
Entity Type:Individual
Prefix:MR
First Name:ALLEN
Middle Name:MICHAEL
Last Name:BROWN
Suffix:
Gender:M
Credentials:MPT, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:632 COLONY RD
Mailing Address - Street 2:
Mailing Address - City:HARTSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29550-7976
Mailing Address - Country:US
Mailing Address - Phone:843-861-2127
Mailing Address - Fax:
Practice Address - Street 1:1109 S 5TH ST
Practice Address - Street 2:SUITE L
Practice Address - City:HARTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29550-5797
Practice Address - Country:US
Practice Address - Phone:843-861-2127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5186225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist