Provider Demographics
NPI:1740262112
Name:BROWN, SAMUEL M (PT)
Entity type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:M
Last Name:BROWN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1 S CREEK DR
Mailing Address - Street 2:STE 116
Mailing Address - City:MONTICELLO
Mailing Address - State:KY
Mailing Address - Zip Code:42633-9472
Mailing Address - Country:US
Mailing Address - Phone:606-348-3314
Mailing Address - Fax:606-348-3315
Practice Address - Street 1:1 S CREEK DR
Practice Address - Street 2:STE 116
Practice Address - City:MONTICELLO
Practice Address - State:KY
Practice Address - Zip Code:42633-9472
Practice Address - Country:US
Practice Address - Phone:606-348-3314
Practice Address - Fax:606-348-3315
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY000553225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY87005534Medicaid
R37623Medicare UPIN
KY5027201Medicare ID - Type Unspecified