Provider Demographics
NPI:1538415146
Name:BROWN, ALEXANDRA (ATC, LAT)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3050 PINEWOOD CT
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34746-3031
Mailing Address - Country:US
Mailing Address - Phone:312-624-0481
Mailing Address - Fax:
Practice Address - Street 1:3050 PINEWOOD CT
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34746-3031
Practice Address - Country:US
Practice Address - Phone:312-624-0481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-01
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL 27512255A2300X
TNAT13622255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer