Provider Demographics
NPI:1013986553
Name:BROWN, STANLEY LEE (PT)
Entity Type:Individual
Prefix:MR
First Name:STANLEY
Middle Name:LEE
Last Name:BROWN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5490 S AARON AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65810-2034
Mailing Address - Country:US
Mailing Address - Phone:417-886-6200
Mailing Address - Fax:417-886-6201
Practice Address - Street 1:902 W BATTLEFIELD ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-4130
Practice Address - Country:US
Practice Address - Phone:417-886-6200
Practice Address - Fax:417-886-6201
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-16
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR0660225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist