Provider Demographics
NPI:1497822134
Name:BROWN, THOMAS CHANDLER (PT)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:CHANDLER
Last Name:BROWN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:MR
Other - First Name:CHAN
Other - Middle Name:
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:206B OXFORD RD
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:MS
Mailing Address - Zip Code:38652-3115
Mailing Address - Country:US
Mailing Address - Phone:662-534-4445
Mailing Address - Fax:662-534-9449
Practice Address - Street 1:3437 TUPELO COMMONS
Practice Address - Street 2:SUITE 102
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38804-9791
Practice Address - Country:US
Practice Address - Phone:662-680-3200
Practice Address - Fax:662-680-5090
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT3177225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS582681044OtherTAX ID #
MS00138736Medicaid
MS256599Medicare ID - Type UnspecifiedMEDICARE ID