Provider Demographics
NPI:1255875084
Name:BROWN, STEFANIE M (PT, DPT)
Entity type:Individual
Prefix:
First Name:STEFANIE
Middle Name:M
Last Name:BROWN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 69030
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-9030
Mailing Address - Country:US
Mailing Address - Phone:757-873-2302
Mailing Address - Fax:757-873-2306
Practice Address - Street 1:9 MANHATTAN SQ
Practice Address - Street 2:SUITE B
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-6262
Practice Address - Country:US
Practice Address - Phone:757-825-3400
Practice Address - Fax:757-825-0392
Is Sole Proprietor?:No
Enumeration Date:2016-12-13
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD25323225100000X
VA2305210800225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAQ55787AOtherINDIVIDUAL MEDICARE PTAN
VAC05954OtherGROUP MEDICARE PTAN
VA1255875084Medicaid