Provider Demographics
NPI:1902851447
Name:BROWN, CAROLYN E (PT)
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:E
Last Name:BROWN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42431-9154
Mailing Address - Country:US
Mailing Address - Phone:270-825-2158
Mailing Address - Fax:270-825-1277
Practice Address - Street 1:121 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:KY
Practice Address - Zip Code:42078-8043
Practice Address - Country:US
Practice Address - Phone:270-988-7213
Practice Address - Fax:270-988-2199
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPT000361225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000178635OtherPROVIDER ID BLUE CROSS BL
KY8700020400Medicaid
KY5023902Medicare ID - Type UnspecifiedMEDICARE ID REIDLAND
KY8700020400Medicaid
KY000000178635OtherPROVIDER ID BLUE CROSS BL
KY5023702Medicare ID - Type UnspecifiedMEDICARE ID SALEM