Provider Demographics
NPI:1184339392
Name:BROWN, MINDY L (CTRS)
Entity type:Individual
Prefix:
First Name:MINDY
Middle Name:L
Last Name:BROWN
Suffix:
Gender:F
Credentials:CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4942 BRIGHTON LN
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-4256
Mailing Address - Country:US
Mailing Address - Phone:901-826-2556
Mailing Address - Fax:
Practice Address - Street 1:1705 S HOLTZCLAW AVE
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-4804
Practice Address - Country:US
Practice Address - Phone:901-826-2556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist