Provider Demographics
NPI:1497117170
Name:BROWN, KIM (MPT)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 DOW ST N
Mailing Address - Street 2:
Mailing Address - City:CANNON FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:55009-1810
Mailing Address - Country:US
Mailing Address - Phone:507-263-6712
Mailing Address - Fax:507-298-3082
Practice Address - Street 1:300 DOW ST N
Practice Address - Street 2:
Practice Address - City:CANNON FALLS
Practice Address - State:MN
Practice Address - Zip Code:55009-1810
Practice Address - Country:US
Practice Address - Phone:507-263-6712
Practice Address - Fax:507-298-3082
Is Sole Proprietor?:No
Enumeration Date:2016-03-22
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4834225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist