Provider Demographics
NPI:1417499211
Name:BROWN, DUSTIN RICHARD (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:DUSTIN
Middle Name:RICHARD
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 1:9364 PORTER RD
Mailing Address - Street 2:
Mailing Address - City:RYLAND HGHT
Mailing Address - State:KY
Mailing Address - Zip Code:41015-9582
Mailing Address - Country:US
Mailing Address - Phone:859-466-3005
Mailing Address - Fax:
Practice Address - Street 1:11808 GRANT ST
Practice Address - Street 2:#100
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68164-3613
Practice Address - Country:US
Practice Address - Phone:877-230-3885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-09
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY005873225100000X
COPTL.0014248225100000X
FLPT 31192225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist