Healthcare Provider Details

I. General information

NPI: 1962512848
Provider Name (Legal Business Name): HEATH DUANE BROWN PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2416 CONSTITUTION AVE REHABILITATION TODAY
OLEAN NY
14760
US

IV. Provider business mailing address

2416 CONSTITUTION AVE REHABILITATION TODAY
OLEAN NY
14760
US

V. Phone/Fax

Practice location:
  • Phone: 716-372-2808
  • Fax: 716-372-2902
Mailing address:
  • Phone: 716-372-2808
  • Fax: 716-372-2902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number011157
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT010752
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier01653245
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: