Individual
DR. CLANCY CLYDE BROWN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT, CSCS
Contact information
Practice address
124 PETERSEN PKWY STE 1, THAYNE, WY 83127-9754
(307) 883-7878
(307) 883-7877
Mailing address
124 PETERSEN PKWY STE 1, THAYNE, WY 83127-9754
(307) 883-7878
(307) 883-7877
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1366
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103956300
—
WY
05
—
117016300
—
WY
05
—
121989800
—
WY
Enumeration date
06/08/2011
Last updated
12/12/2012
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