Healthcare Provider Details

I. General information

NPI: 1467700534
Provider Name (Legal Business Name): KEVIN MICHAEL BROWN DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2012
Last Update Date: 07/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

768 PARK MEADOW RD
WESTERVILLE OH
43081-2871
US

IV. Provider business mailing address

768 PARK MEADOW RD
WESTERVILLE OH
43081-2871
US

V. Phone/Fax

Practice location:
  • Phone: 614-392-2732
  • Fax: 614-392-2792
Mailing address:
  • Phone: 614-392-2732
  • Fax: 614-392-2792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number013911
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: