Provider Demographics
NPI:1902858632
Name:BROWN PHYSICAL THERAPY SERVICE
Entity Type:Organization
Organization Name:BROWN PHYSICAL THERAPY SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR PT
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:HAMILTON
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:270-988-7213
Mailing Address - Street 1:139 HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42431-9154
Mailing Address - Country:US
Mailing Address - Phone:270-825-2158
Mailing Address - Fax:270-825-1277
Practice Address - Street 1:121 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:KY
Practice Address - Zip Code:42078-8043
Practice Address - Country:US
Practice Address - Phone:270-988-7213
Practice Address - Fax:270-988-2199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY000360225100000X
KY000361225100000X
KY002095225100000X
KY002363225100000X
KY000477225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY20042202OtherPROVIDER NUMBER
KY8790027000Medicaid
KY8814Medicare ID - Type UnspecifiedPROVIDER NUMBER