Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 1107274 | TX |
NPI | 1316571094 |
---|---|
Provider Name | Angela Kristine Brown |
First Address | Bryan, TX 77808-7675 |
Second Address | Bryan, TX 77802-5214 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/03/2020 |
Last Update Date | 06/03/2020 |