Healthcare Provider Details

I. General information

NPI: 1215158886
Provider Name (Legal Business Name): RANDY BROWN L..M.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2190 WAPAKONETA AVE
SIDNEY OH
45365
US

IV. Provider business mailing address

9555 CR RD 25A NORTH
SIDNEY OH
45365
US

V. Phone/Fax

Practice location:
  • Phone: 937-726-0068
  • Fax: 937-493-0468
Mailing address:
  • Phone: 937-726-0068
  • Fax: 937-493-0468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License Number9015
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: