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General NPI Number Information
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NPI Number | 1285283689
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Entity Type | Individual
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Provider Name | KRISTOPHER BROWN CF LVL 1, USAW COACH
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Gender | Male
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Dates
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Enumeration Date | 09/09/2019
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Last Update Date | 09/09/2019
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Provider Practice Location Address
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Address Line | 1309 S KILLIAN DR UNIT A
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City | LAKE PARK
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State | FL
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Zip | 33403-1954
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Country | US
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Telephone | 561-856-0908
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Fax |
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Provider Business Mailing Address
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Address Line | 6467 CHASEWOOD DR APT G
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City | JUPITER
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State | FL
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Zip | 33458-5832
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Country | US
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Telephone | 561-856-0908
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0019X
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Taxonomy Name | Physical Rehabilitation Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State |
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