Provider Demographics
NPI:1134365224
Name:BROWN, MONA LISA-W (LPTA)
Entity type:Individual
Prefix:MRS
First Name:MONA
Middle Name:LISA-W
Last Name:BROWN
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 1:496 3RD LOOP RD APT F
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29505-3749
Mailing Address - Country:US
Mailing Address - Phone:843-669-7794
Mailing Address - Fax:
Practice Address - Street 1:121 E CEDAR ST FL 4
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-2576
Practice Address - Country:US
Practice Address - Phone:843-661-3426
Practice Address - Fax:843-661-3599
Is Sole Proprietor?:No
Enumeration Date:2008-12-19
Last Update Date:2008-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1650225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant