Healthcare Provider Details

I. General information

NPI: 1285772574
Provider Name (Legal Business Name): ANTHONY BROWN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2881 TRICOM ST
NORTH CHARLESTON SC
29406-9172
US

IV. Provider business mailing address

PO BOX 1390
MT PLEASANT SC
29465-1390
US

V. Phone/Fax

Practice location:
  • Phone: 843-824-2183
  • Fax: 843-553-3221
Mailing address:
  • Phone: 843-884-7880
  • Fax: 843-884-6635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3678
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: