Provider Demographics
NPI:1205102605
Name:BROWN, JONATHAN (PTL)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:BROWN
Suffix:
Gender:M
Credentials:PTL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2140 HOLLOW BROOK DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-1452
Mailing Address - Country:US
Mailing Address - Phone:719-596-5000
Mailing Address - Fax:
Practice Address - Street 1:2140 HOLLOW BROOK DR
Practice Address - Street 2:SUITE 200
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-1452
Practice Address - Country:US
Practice Address - Phone:719-596-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-29
Last Update Date:2012-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00000225100000X
CO11601225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist