Healthcare Provider Details

I. General information

NPI: 1730367400
Provider Name (Legal Business Name): DAMON BROWN PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2008
Last Update Date: 07/18/2022
Certification Date: 07/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

822 S ROBERTSON BLVD SUITE 310
LOS ANGELES CA
90035-1613
US

IV. Provider business mailing address

822 S ROBERTSON BLVD SUITE 310
LOS ANGELES CA
90035-1613
US

V. Phone/Fax

Practice location:
  • Phone: 310-360-9069
  • Fax: 310-360-0840
Mailing address:
  • Phone: 310-360-9069
  • Fax: 310-360-0840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: