Provider Demographics
NPI:1912966565
Name:BROWN, JAMES R (PT)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:R
Last Name:BROWN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
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Mailing Address - Street 1:147 MILK ST
Mailing Address - Street 2:PROVIDER ENROLLMENT 9TH FLOOR
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02109-4806
Mailing Address - Country:US
Mailing Address - Phone:617-559-8051
Mailing Address - Fax:
Practice Address - Street 1:485 ARSENAL ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-5091
Practice Address - Country:US
Practice Address - Phone:617-972-5255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA15619225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA908025OtherTUFTS HEALTH PLAN
MAY67964OtherBLUE CROSS
MA0024452OtherNEIGHBORHOOD HEALTH PLAN
MAB501027OtherCIGNA
MA0396010Medicaid
MAHV0001OtherHARVARD PILGRIM
MAHV0001OtherHARVARD PILGRIM