Healthcare Provider Details

I. General information

NPI: 1306222799
Provider Name (Legal Business Name): PRESTON BROWN PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2015
Last Update Date: 11/01/2022
Certification Date: 11/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

519 UNIVERSITY PL STE 119
DURANT OK
74701-7102
US

IV. Provider business mailing address

1200 CORPORATE DR STE 400
HOOVER AL
35242-5424
US

V. Phone/Fax

Practice location:
  • Phone: 580-634-7556
  • Fax: 580-319-7904
Mailing address:
  • Phone: 423-777-6236
  • Fax: 423-954-7399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1262136
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number115430
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: