=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033585674
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KEVIN A BROWN DPT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/18/2015
-----------------------------------------------------
Last Update Date | 10/17/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 117 EASTWIND CT
-----------------------------------------------------
City | HAWESVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42348-6736
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-926-8145
-----------------------------------------------------
Fax | 270-926-8147
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 127
-----------------------------------------------------
City | OWENSBORO
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42302-0127
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-427-8066
-----------------------------------------------------
Fax | 603-501-0495
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 006639
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------