Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | PTA5274 | AL |
NPI | 1003062324 |
---|---|
Provider Name | Tosha Brown |
First Address | Montgomery, AL 36117-7310 |
Second Address | Mccomb, MS 39648-3926 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2008 |
Last Update Date | 18/08/2008 |