Provider Demographics
NPI:1841863503
Name:BROWN, LYDIA ANN (PTA)
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:ANN
Last Name:BROWN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12100 NASHVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:TN
Mailing Address - Zip Code:37095-3544
Mailing Address - Country:US
Mailing Address - Phone:615-464-8079
Mailing Address - Fax:
Practice Address - Street 1:825 FISHER AVE
Practice Address - Street 2:
Practice Address - City:SMITHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37166-2140
Practice Address - Country:US
Practice Address - Phone:615-597-4284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-21
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7772225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant