Provider Demographics
NPI:1710116678
Name:BROWN, CORRIE LYNN (PT, DPT, OCS)
Entity Type:Individual
Prefix:
First Name:CORRIE
Middle Name:LYNN
Last Name:BROWN
Suffix:
Gender:F
Credentials:PT, DPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1633 S VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:ATOKA
Mailing Address - State:OK
Mailing Address - Zip Code:74525-3901
Mailing Address - Country:US
Mailing Address - Phone:580-364-7090
Mailing Address - Fax:844-203-9997
Practice Address - Street 1:1633 S VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:ATOKA
Practice Address - State:OK
Practice Address - Zip Code:74525-3901
Practice Address - Country:US
Practice Address - Phone:580-364-7090
Practice Address - Fax:844-203-9997
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-13
Last Update Date:2017-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4788225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist