Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 1182208 | TX |
NPI | 1003136425 |
---|---|
Provider Name | Ms. Trisha Lee Brown |
First Address | Longview, TX 75601-2912 |
Second Address | Longview, TX 75601-2912 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2010 |
Last Update Date | 17/06/2021 |