Healthcare Provider Details

I. General information

NPI: 1700780780
Provider Name (Legal Business Name): JUSTIN BROWN LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1610 W 11TH ST
ASHTABULA OH
44004-2906
US

IV. Provider business mailing address

39000 MENTOR AVE
WILLOUGHBY OH
44094-8095
US

V. Phone/Fax

Practice location:
  • Phone: 440-536-5475
  • Fax: 440-953-3953
Mailing address:
  • Phone: 440-953-3950
  • Fax: 440-953-3953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number33.023441
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: