Provider Demographics
NPI:1750464947
Name:BROWN, GARY ALAN (PT)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:ALAN
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 1:195 TOPAZ CIR
Mailing Address - Street 2:
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-9677
Mailing Address - Country:US
Mailing Address - Phone:330-519-1308
Mailing Address - Fax:330-533-0282
Practice Address - Street 1:195 TOPAZ CIR
Practice Address - Street 2:
Practice Address - City:CANFIELD
Practice Address - State:OH
Practice Address - Zip Code:44406-9677
Practice Address - Country:US
Practice Address - Phone:330-519-1308
Practice Address - Fax:330-533-0282
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT04074225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0000003222666OtherANTHEM
OH287663668006OtherMEDICAL MUTUAL