Provider Demographics
NPI:1700151735
Name:BROWN, JUSTIN CHARLES (MPT)
Entity Type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:CHARLES
Last Name:BROWN
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:29803 SANTA MARGARITA PKWY
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA MARGARITA
Mailing Address - State:CA
Mailing Address - Zip Code:92688-3609
Mailing Address - Country:US
Mailing Address - Phone:949-459-9010
Mailing Address - Fax:949-459-9020
Practice Address - Street 1:29803 SANTA MARGARITA PKWY
Practice Address - Street 2:
Practice Address - City:RANCHO SANTA MARGARITA
Practice Address - State:CA
Practice Address - Zip Code:92688
Practice Address - Country:US
Practice Address - Phone:949-459-9010
Practice Address - Fax:949-459-9020
Is Sole Proprietor?:No
Enumeration Date:2012-03-08
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA388082251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic