Provider Demographics
NPI:1689061772
Name:BROWN, NICOLE J (PT, DPT)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:J
Last Name:BROWN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5300 DERRY ST FL 2
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17111-3576
Mailing Address - Country:US
Mailing Address - Phone:717-839-2110
Mailing Address - Fax:717-565-1934
Practice Address - Street 1:998 HOSPITALITY WAY STE 101
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:MD
Practice Address - Zip Code:21001-1757
Practice Address - Country:US
Practice Address - Phone:410-273-9776
Practice Address - Fax:410-273-9777
Is Sole Proprietor?:No
Enumeration Date:2015-04-16
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD25408225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist