Provider Demographics
NPI:1073687745
Name:DAMON BROWN PT
Entity Type:Organization
Organization Name:DAMON BROWN PT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAMON
Authorized Official - Middle Name:R
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:RPT OCS
Authorized Official - Phone:310-360-9069
Mailing Address - Street 1:2405 W 170TH STREET
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90504-2835
Mailing Address - Country:US
Mailing Address - Phone:310-360-9069
Mailing Address - Fax:310-360-0840
Practice Address - Street 1:822 S ROBERTSON BLVD
Practice Address - Street 2:#310
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035
Practice Address - Country:US
Practice Address - Phone:310-606-5664
Practice Address - Fax:310-606-5668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT169352251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW17156AMedicaid
CAW1756Medicare ID - Type Unspecified
Y06681Medicare UPIN