Provider Demographics
NPI:1801843040
Name:BROWN, WILLIAM F (PTC)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:F
Last Name:BROWN
Suffix:
Gender:M
Credentials:PTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10130 AVONLEIGH DR
Mailing Address - Street 2:
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34135-7019
Mailing Address - Country:US
Mailing Address - Phone:443-742-4206
Mailing Address - Fax:
Practice Address - Street 1:10130 AVONLEIGH DR
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34135-7019
Practice Address - Country:US
Practice Address - Phone:443-742-4206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23066225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q53736Medicare UPIN
K552M454Medicare UPIN