Provider Demographics
NPI:1417169970
Name:BROWN, LARRY GENE (ATC)
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:GENE
Last Name:BROWN
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32213 7TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98023-5523
Mailing Address - Country:US
Mailing Address - Phone:253-988-4323
Mailing Address - Fax:425-837-4883
Practice Address - Street 1:16655 SE 136TH ST
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98059-6950
Practice Address - Country:US
Practice Address - Phone:425-837-4914
Practice Address - Fax:425-837-4883
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer