Provider Demographics
NPI:1750554655
Name:BROWN, RONNIE (DPT)
Entity type:Individual
Prefix:
First Name:RONNIE
Middle Name:
Last Name:BROWN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12997 NETTLES DR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23602-6913
Mailing Address - Country:US
Mailing Address - Phone:757-249-8880
Mailing Address - Fax:
Practice Address - Street 1:12997 NETTLES DR
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23602-6913
Practice Address - Country:US
Practice Address - Phone:757-249-8880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-11
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT21568225100000X
GAPT009074225100000X
VA2305207383225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPT009074OtherLICENSE
VA2305207383OtherLICENSE