Provider Demographics
NPI:1174672661
Name:BROWN, TRICIA SHIPE (PT, STC)
Entity type:Individual
Prefix:
First Name:TRICIA
Middle Name:SHIPE
Last Name:BROWN
Suffix:
Gender:F
Credentials:PT, STC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4101 TATES CREEK CENTRE DR
Mailing Address - Street 2:SUITE 144
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40517-3066
Mailing Address - Country:US
Mailing Address - Phone:859-271-2887
Mailing Address - Fax:859-271-2889
Practice Address - Street 1:4101 TATES CREEK CENTRE DR
Practice Address - Street 2:SUITE 144
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40517-3066
Practice Address - Country:US
Practice Address - Phone:859-271-2887
Practice Address - Fax:859-271-2889
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY003875225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist