Provider Demographics
NPI:1609030154
Name:BROWN, MINDY (PTA)
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1397 S COLLEGE ST
Mailing Address - Street 2:P.O. BOX 4
Mailing Address - City:WINCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37398-2414
Mailing Address - Country:US
Mailing Address - Phone:931-962-3225
Mailing Address - Fax:931-962-3103
Practice Address - Street 1:1397 S COLLEGE ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37398-2414
Practice Address - Country:US
Practice Address - Phone:931-962-3225
Practice Address - Fax:931-962-3103
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-14
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPTA0000004327225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant