Provider Demographics
NPI:1922266998
Name:BROWN, MARY MARGARET (PT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:MARGARET
Last Name:BROWN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:MARY
Other - Middle Name:MARGARET
Other - Last Name:BJORK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:701 OLYMPIC PLAZA CIR
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-1950
Mailing Address - Country:US
Mailing Address - Phone:903-849-4404
Mailing Address - Fax:903-849-2304
Practice Address - Street 1:321 HWY 31E
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:TX
Practice Address - Zip Code:75758
Practice Address - Country:US
Practice Address - Phone:903-849-4404
Practice Address - Fax:903-849-2304
Is Sole Proprietor?:No
Enumeration Date:2008-05-27
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1098226225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist