Healthcare Provider Details

I. General information

NPI: 1144437765
Provider Name (Legal Business Name): RANDALL A BROWN DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 04/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3915 8TH AVE W
BRADENTON FL
34205-1701
US

IV. Provider business mailing address

1800 CORTEZ RD W
BRADENTON FL
34207-1335
US

V. Phone/Fax

Practice location:
  • Phone: 941-747-7741
  • Fax: 941-747-1431
Mailing address:
  • Phone: 941-758-8818
  • Fax: 941-755-2901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT23057
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: