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General NPI Number Information
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NPI Number | 1447761168
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Entity Type | Individual
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Provider Name | MICHAEL JAMES BROWN PTA, BS, AS
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Gender | Male
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Dates
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Enumeration Date | 10/20/2017
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Last Update Date | 10/20/2017
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Provider Practice Location Address
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Address Line | 102 IRVING ST NW
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City | WASHINGTON
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State | DC
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Zip | 20010-2921
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Country | US
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Telephone | 855-633-0204
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Fax |
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Provider Business Mailing Address
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Address Line | 984 CENTRAL AVE
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City | NEEDHAM
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State | MA
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Zip | 02492
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Country | US
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Telephone | 617-775-2188
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA000167
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License Number State | DC
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