Provider Demographics
NPI:1467809046
Name:BROWN, ETHAN WILLIAM (DPT)
Entity Type:Individual
Prefix:
First Name:ETHAN
Middle Name:WILLIAM
Last Name:BROWN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2700 STANLEY GAULT PKWY
Mailing Address - Street 2:STE 129
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-5176
Mailing Address - Country:US
Mailing Address - Phone:502-253-4918
Mailing Address - Fax:502-489-5751
Practice Address - Street 1:2206 STATE ST
Practice Address - Street 2:SUITE 300
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-4925
Practice Address - Country:US
Practice Address - Phone:812-206-0200
Practice Address - Fax:812-206-0002
Is Sole Proprietor?:No
Enumeration Date:2016-05-24
Last Update Date:2020-12-08
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist