Provider Demographics
NPI:1043477979
Name:BROWN, STEVEN ALLEN (PTA)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:ALLEN
Last Name:BROWN
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 CARTER ST APT 213
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37210-5355
Mailing Address - Country:US
Mailing Address - Phone:208-600-9013
Mailing Address - Fax:208-600-9013
Practice Address - Street 1:327 S 20TH ST
Practice Address - Street 2:
Practice Address - City:PAYETTE
Practice Address - State:ID
Practice Address - Zip Code:83661-3033
Practice Address - Country:US
Practice Address - Phone:208-453-1522
Practice Address - Fax:208-453-1591
Is Sole Proprietor?:No
Enumeration Date:2008-05-19
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR8620225200000X
IDPTA-179225200000X
TN7943225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORPTA-8620OtherSTATE OF OREGON
IDPTA-179OtherIDAHO LICENSE NUMBER