Healthcare Provider Details

I. General information

NPI: 1871710814
Provider Name (Legal Business Name): LARRY BROWN D/B/A COAST PHYSICAL THERAPY SPEC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 04/24/2012
Certification Date:
Deactivation Date: 08/12/2008
Reactivation Date: 04/24/2012

III. Provider practice location address

1701 SOLAR DR STE. 155
OXNARD CA
93030-0134
US

IV. Provider business mailing address

1701 SOLAR DR STE. 155
OXNARD CA
93030-0134
US

V. Phone/Fax

Practice location:
  • Phone: 805-604-4644
  • Fax: 805-604-4434
Mailing address:
  • Phone: 805-604-4644
  • Fax: 805-604-4434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number07-00073195
License Number StateCA

VIII. Authorized Official

Name: MR. LARRY PATRICK BROWN
Title or Position: OWNER
Credential: PT
Phone: 805-604-4644