Provider Demographics
NPI:1568422988
Name:BROWN, MARK E (PT)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:E
Last Name:BROWN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
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Mailing Address - Street 1:16 NW 63RD ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-9116
Mailing Address - Country:US
Mailing Address - Phone:405-419-8447
Mailing Address - Fax:405-419-7745
Practice Address - Street 1:1717 W 33RD ST
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-3819
Practice Address - Country:US
Practice Address - Phone:405-340-2025
Practice Address - Fax:405-340-6649
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK3421225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist