Provider Demographics
NPI:1801675079
Name:BROWN, TRACY D
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:D
Last Name:BROWN
Suffix:
Gender:F
Credentials:
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 389
Mailing Address - Street 2:
Mailing Address - City:STRONG
Mailing Address - State:ME
Mailing Address - Zip Code:04983-0389
Mailing Address - Country:US
Mailing Address - Phone:207-779-7331
Mailing Address - Fax:
Practice Address - Street 1:24 MARTIN LN
Practice Address - Street 2:
Practice Address - City:BELFAST
Practice Address - State:ME
Practice Address - Zip Code:04915-6099
Practice Address - Country:US
Practice Address - Phone:207-667-9036
Practice Address - Fax:207-667-7197
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-26
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT1128225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist