Individual
AMANDA M BROWN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
605 N 12TH ST, MOUNT VERNON, IL 62864-2857
(618) 436-8640
Mailing address
PO BOX 503927, SAINT LOUIS, MO 63150-0001
(618) 436-8640
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
070013466
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
070013466
STATE LICENSE NUMBER
IL
Enumeration date
02/21/2007
Last updated
11/15/2012
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