Provider Demographics
NPI:1013213917
Name:BROWN, KYLE BRANDON (DPT)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:BRANDON
Last Name:BROWN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:24226 PAULSON DR
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-4872
Mailing Address - Country:US
Mailing Address - Phone:707-292-7154
Mailing Address - Fax:707-224-2356
Practice Address - Street 1:18200 YORBA LINDA BLVD
Practice Address - Street 2:SUITE 307, 308
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92886-4056
Practice Address - Country:US
Practice Address - Phone:707-224-3131
Practice Address - Fax:707-224-2356
Is Sole Proprietor?:No
Enumeration Date:2011-02-10
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 37163225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist