Basic Information
| Provider Information | |||||||||
| NPI: | 1457332611 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BROWN | ||||||||
| FirstName: | CHESTER | ||||||||
| MiddleName: | MARK | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2404 S LOCUST ST | ||||||||
| Address2: | STE 5 | ||||||||
| City: | LAS CRUCES | ||||||||
| State: | NM | ||||||||
| PostalCode: | 880015789 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5755214188 | ||||||||
| FaxNumber: | 5755213668 | ||||||||
| Practice Location | |||||||||
| Address1: | 1834 JACLIF CT | ||||||||
| Address2: | SUITE A | ||||||||
| City: | TALLAHASSEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 323084400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8506561837 | ||||||||
| FaxNumber: | 8508772917 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2005 | ||||||||
| LastUpdateDate: | 02/14/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT 23928 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.