Provider Demographics
NPI:1750438727
Name:BROWN, LYNDA D (PT)
Entity type:Individual
Prefix:MRS
First Name:LYNDA
Middle Name:D
Last Name:BROWN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1726 BECK AVE
Mailing Address - Street 2:
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414-3925
Mailing Address - Country:US
Mailing Address - Phone:307-587-9866
Mailing Address - Fax:307-587-9867
Practice Address - Street 1:1819 SHERIDAN AVE
Practice Address - Street 2:
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-3886
Practice Address - Country:US
Practice Address - Phone:307-587-9866
Practice Address - Fax:307-587-9867
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY323225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY110657100Medicaid
WY9834Medicare ID - Type Unspecified