Provider Demographics
NPI:1396890885
Name:BROWN CHAMBERS, ANGIE DEANNA (MPT)
Entity type:Individual
Prefix:MRS
First Name:ANGIE
Middle Name:DEANNA
Last Name:BROWN CHAMBERS
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:ANGIE
Other - Middle Name:
Other - Last Name:CHAMBERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:1415 AARON CREEK DR
Mailing Address - Street 2:
Mailing Address - City:FISHERVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40023-7780
Mailing Address - Country:US
Mailing Address - Phone:502-777-3255
Mailing Address - Fax:
Practice Address - Street 1:3584 SPRINGHURST BLVD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-4141
Practice Address - Country:US
Practice Address - Phone:502-339-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0040262251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics