Healthcare Provider Details

I. General information

NPI: 1073687745
Provider Name (Legal Business Name): DAMON BROWN PT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

822 S ROBERTSON BLVD #310
LOS ANGELES CA
90035
US

IV. Provider business mailing address

2405 W 170TH STREET
TORRANCE CA
90504-2835
US

V. Phone/Fax

Practice location:
  • Phone: 310-606-5664
  • Fax: 310-606-5668
Mailing address:
  • Phone: 310-360-9069
  • Fax: 310-360-0840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT16935
License Number StateCA

VIII. Authorized Official

Name: DAMON R BROWN
Title or Position: OWNER
Credential: RPT OCS
Phone: 310-360-9069