Provider Demographics
NPI:1497362552
Name:BROWN, DEVIN ASHLEY (LMTCMT)
Entity Type:Individual
Prefix:
First Name:DEVIN
Middle Name:ASHLEY
Last Name:BROWN
Suffix:
Gender:F
Credentials:LMTCMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3411 MORGAN AVE N
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55412-2335
Mailing Address - Country:US
Mailing Address - Phone:612-850-6266
Mailing Address - Fax:
Practice Address - Street 1:340 CEDAR ST
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-1100
Practice Address - Country:US
Practice Address - Phone:651-291-7722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist