Provider Demographics
NPI:1750502613
Name:BROWN, KEVIN DEAN (PT)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:DEAN
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 1:654 BRAE MAR CT
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-2378
Mailing Address - Country:US
Mailing Address - Phone:760-809-1502
Mailing Address - Fax:
Practice Address - Street 1:654 BRAE MAR CT
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-2378
Practice Address - Country:US
Practice Address - Phone:760-809-1502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 26670225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist