Healthcare Provider Details

I. General information

NPI: 1992839260
Provider Name (Legal Business Name): DAMON BROWN PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 08/22/2020
Certification Date:
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 Number16935
License Number StateCA

VIII. Authorized Official

Name: MR. DAMON BROWN
Title or Position: PHYSICAL THERAPIST, OWNER
Credential: P.T., O.C.S.
Phone: 310-360-9069