Provider Demographics
NPI:1093436420
Name:BROWN, AVONLEA (DPT, PT)
Entity Type:Individual
Prefix:
First Name:AVONLEA
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15375 BARRANCA PKWY STE A103
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-2203
Mailing Address - Country:US
Mailing Address - Phone:949-590-9350
Mailing Address - Fax:949-346-5350
Practice Address - Street 1:15375 BARRANCA PKWY STE A103
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-2203
Practice Address - Country:US
Practice Address - Phone:949-590-9350
Practice Address - Fax:949-346-5350
Is Sole Proprietor?:No
Enumeration Date:2022-09-05
Last Update Date:2022-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA302527225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist