Provider Demographics
NPI:1588831671
Name:BROWN, NICOLE MARIA (LPTA)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:MARIA
Last Name:BROWN
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:791 ABEES GROVE CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:VALDESE
Mailing Address - State:NC
Mailing Address - Zip Code:28690-8745
Mailing Address - Country:US
Mailing Address - Phone:828-893-0015
Mailing Address - Fax:
Practice Address - Street 1:791 ABEES GROVE CHURCH RD
Practice Address - Street 2:
Practice Address - City:VALDESE
Practice Address - State:NC
Practice Address - Zip Code:28690-8745
Practice Address - Country:US
Practice Address - Phone:828-893-0015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-08
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3040225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant