Provider Demographics
NPI:1679749329
Name:BROWN, ROBERT NIEL (PT)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:NIEL
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 1:1802 S UNION AVE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-1947
Mailing Address - Country:US
Mailing Address - Phone:253-756-8668
Mailing Address - Fax:253-759-5138
Practice Address - Street 1:1802 S UNION AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1947
Practice Address - Country:US
Practice Address - Phone:253-756-8668
Practice Address - Fax:756-759-5138
Is Sole Proprietor?:No
Enumeration Date:2008-05-02
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00003144225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7071921Medicaid
WA137828OtherPREMERA BLUE CROSS
WA104051OtherLABOR AND INDUSTRIES
WABR5649OtherREGENCE