Provider Demographics
NPI:1902910524
Name:BROWN, ANGELA M (PT)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:M
Last Name:BROWN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:162 MANSFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:WILLIMANTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06626-2026
Mailing Address - Country:US
Mailing Address - Phone:860-456-2232
Mailing Address - Fax:860-456-2256
Practice Address - Street 1:162 MANSFIELD AVE
Practice Address - Street 2:
Practice Address - City:WILLIMANTIC
Practice Address - State:CT
Practice Address - Zip Code:06626-2026
Practice Address - Country:US
Practice Address - Phone:860-456-2232
Practice Address - Fax:860-456-2256
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT006083225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT650001236Medicare PIN