Provider Demographics
NPI:1346816915
Name:BROWN, STACY M (LMT)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:M
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 1:2259 MILLSTONE DR UNIT A
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77073-1561
Mailing Address - Country:US
Mailing Address - Phone:832-510-5160
Mailing Address - Fax:
Practice Address - Street 1:17907 KUYKENDAHL RD STE 302
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-8152
Practice Address - Country:US
Practice Address - Phone:832-510-5160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-03
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT133516225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty