Healthcare Provider Details

I. General information

NPI: 1477535607
Provider Name (Legal Business Name): RANDY M. BROWN M.P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: RANDY MATTHEW BROWN M.P.T.

II. Dates (important events)

Enumeration Date: 11/15/2005
Last Update Date: 01/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 GREENUP AVE
ASHLAND KY
41101-1953
US

IV. Provider business mailing address

353 BLACKBURN AVE
ASHLAND KY
41101-3479
US

V. Phone/Fax

Practice location:
  • Phone: 800-609-0905
  • Fax: 800-609-0801
Mailing address:
  • Phone: 606-615-1774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number004537
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 010979
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: