Provider Demographics
NPI:1306222799
Name:BROWN, PRESTON (PT, DPT)
Entity Type:Individual
Prefix:
First Name:PRESTON
Middle Name:
Last Name:BROWN
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 CORPORATE DR STE 400
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35242-5424
Mailing Address - Country:US
Mailing Address - Phone:423-777-6236
Mailing Address - Fax:423-954-7399
Practice Address - Street 1:519 UNIVERSITY PL STE 119
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-7102
Practice Address - Country:US
Practice Address - Phone:580-634-7556
Practice Address - Fax:580-319-7904
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-07
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1262136225100000X
OK115430225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist