Provider Demographics
NPI:1790125516
Name:BROWN, PATRICIA M (PTA)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:M
Last Name:BROWN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:M
Other - Last Name:ZELLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:4940 THUNDERBIRD CIR APT 321
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-3968
Mailing Address - Country:US
Mailing Address - Phone:719-242-7161
Mailing Address - Fax:
Practice Address - Street 1:4940 THUNDERBIRD CIR APT 321
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-3968
Practice Address - Country:US
Practice Address - Phone:719-242-7161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-25
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO12889225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant