Provider Demographics
NPI:1972563625
Name:BROWN, STEPHANIE DENISE (PT)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:DENISE
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 1:4 SEZANNE CV
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223-5093
Mailing Address - Country:US
Mailing Address - Phone:501-786-4042
Mailing Address - Fax:
Practice Address - Street 1:5312 W 10TH ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72204-1852
Practice Address - Country:US
Practice Address - Phone:501-786-4042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-26
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9673225100000X
AR2347225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7211907Medicaid
AR140282721Medicaid
NC7211907Medicaid