Provider Demographics
NPI:1609079391
Name:BROWN, CAROL REYNOLDS (PTA)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:REYNOLDS
Last Name:BROWN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MISS
Other - First Name:CAROL
Other - Middle Name:LEE
Other - Last Name:REYNOLDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:100 BOSTWICK RDG
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-8922
Mailing Address - Country:US
Mailing Address - Phone:803-865-6298
Mailing Address - Fax:
Practice Address - Street 1:7601 PARKLANE RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-6122
Practice Address - Country:US
Practice Address - Phone:803-741-9090
Practice Address - Fax:803-741-1914
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1344225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant