Provider Demographics
NPI:1932204104
Name:BROWN, ANTHONY RYAN (LMT)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:RYAN
Last Name:BROWN
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 Q ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-2120
Mailing Address - Country:US
Mailing Address - Phone:541-606-5954
Mailing Address - Fax:
Practice Address - Street 1:380 Q ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-2120
Practice Address - Country:US
Practice Address - Phone:541-606-5954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR12999225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist