Provider Demographics
NPI:1538119383
Name:BROWN, KEVIN M (ATC)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:M
Last Name:BROWN
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:214 MIDDLETOWN SQ
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40243-1462
Mailing Address - Country:US
Mailing Address - Phone:502-994-0709
Mailing Address - Fax:
Practice Address - Street 1:12935 SHELBYVILLE RD
Practice Address - Street 2:SUITE 106
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40243-1592
Practice Address - Country:US
Practice Address - Phone:502-489-5002
Practice Address - Fax:502-489-8002
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYAT6722255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer