Provider Demographics
NPI:1639368111
Name:BROWN, WILICIA (PTA)
Entity Type:Individual
Prefix:MS
First Name:WILICIA
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 1:18108 S PARKVIEW DR APT M38
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-6593
Mailing Address - Country:US
Mailing Address - Phone:281-829-5617
Mailing Address - Fax:
Practice Address - Street 1:8955 LONG POINT DR
Practice Address - Street 2:C/O SPRING BRANCH HEALTH CARE CENTER
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055
Practice Address - Country:US
Practice Address - Phone:713-464-7625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-19
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007006870225200000X
TX2062079225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant