Provider Demographics
NPI:1811021173
Name:BROUN, VIRGINIA LYNN (LPTA)
Entity Type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:LYNN
Last Name:BROUN
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2260 KINDLING HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-3847
Mailing Address - Country:US
Mailing Address - Phone:757-427-2172
Mailing Address - Fax:
Practice Address - Street 1:2260 KINDLING HOLLOW RD
Practice Address - Street 2:1309 KEMPSVILLE RD
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456-3847
Practice Address - Country:US
Practice Address - Phone:757-427-2172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306001297225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant