Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 1270825 | TX |
NPI | 1720449564 |
---|---|
Provider Name | Hannah Brown |
First Address | Southlake, TX 76092-9416 |
Second Address | Fort Worth, TX 76104-1022 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2016 |
Last Update Date | 07/03/2016 |