Provider Demographics
NPI:1295829232
Name:BROWN, DAVID LANE (MSPT)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:LANE
Last Name:BROWN
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9204 TAYLORSVILLE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-1787
Mailing Address - Country:US
Mailing Address - Phone:502-499-5959
Mailing Address - Fax:502-499-5454
Practice Address - Street 1:9204 TAYLORSVILLE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40299-1787
Practice Address - Country:US
Practice Address - Phone:502-499-5959
Practice Address - Fax:502-499-5454
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY003788225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0930401Medicare ID - Type Unspecified