Provider Demographics
NPI:1326039322
Name:BROWN, LARRY PATRICK (PT)
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:PATRICK
Last Name:BROWN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 SOLAR DR
Mailing Address - Street 2:SUITE 155
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93030-0139
Mailing Address - Country:US
Mailing Address - Phone:805-604-4644
Mailing Address - Fax:805-604-4434
Practice Address - Street 1:1701 SOLAR DR
Practice Address - Street 2:SUITE 155
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-0134
Practice Address - Country:US
Practice Address - Phone:805-604-4644
Practice Address - Fax:805-604-4434
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-31
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT11448225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT 11448AMedicare ID - Type Unspecified