Provider Demographics
NPI:1457332611
Name:BROWN, CHESTER MARK (PT)
Entity Type:Individual
Prefix:
First Name:CHESTER
Middle Name:MARK
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 1:2404 S LOCUST ST
Mailing Address - Street 2:STE 5
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-5789
Mailing Address - Country:US
Mailing Address - Phone:575-521-4188
Mailing Address - Fax:575-521-3668
Practice Address - Street 1:1834 JACLIF CT
Practice Address - Street 2:SUITE A
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4400
Practice Address - Country:US
Practice Address - Phone:850-656-1837
Practice Address - Fax:850-877-2917
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 23928225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAK396ZMedicare PIN