Provider Demographics
NPI:1922371335
Name:BROWN PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:BROWN PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:W
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:714-636-7410
Mailing Address - Street 1:5851 LANCEFIELD DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92649-4904
Mailing Address - Country:US
Mailing Address - Phone:760-218-1400
Mailing Address - Fax:714-840-3694
Practice Address - Street 1:13071 BROOKHURST ST
Practice Address - Street 2:SUITE 110
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-1091
Practice Address - Country:US
Practice Address - Phone:714-636-7410
Practice Address - Fax:714-636-6874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-15
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPTAN HM118AMedicare UPIN