Provider Demographics
NPI:1467527598
Name:BROWN, ANDREW LOREN (PT)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:LOREN
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 1:42 S CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:OH
Mailing Address - Zip Code:44047-1311
Mailing Address - Country:US
Mailing Address - Phone:440-293-8654
Mailing Address - Fax:440-293-8654
Practice Address - Street 1:42 S CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:OH
Practice Address - Zip Code:44047-1311
Practice Address - Country:US
Practice Address - Phone:440-293-8654
Practice Address - Fax:440-293-8654
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT-007159225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000517517OtherBLUE CROSS BLUE SHIELD
OHP00415098OtherRAILROAD MEDICARE
OH2745935Medicaid
OH4202341Medicare PIN