Provider Demographics
NPI:1609346279
Name:BROWN, WILLIAM (PT, DPT)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
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:P.O. BOX 945
Mailing Address - Street 2:
Mailing Address - City:SODA SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:95728
Mailing Address - Country:US
Mailing Address - Phone:530-214-9094
Mailing Address - Fax:
Practice Address - Street 1:21666 LOTTA CRABTREE TER
Practice Address - Street 2:
Practice Address - City:SODA SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:95728
Practice Address - Country:US
Practice Address - Phone:530-214-9094
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-27
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3619225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist