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General NPI Number Information
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NPI Number | 1467809046
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Entity Type | Individual
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Provider Name | ETHAN WILLIAM BROWN DPT
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Gender | Male
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Dates
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Enumeration Date | 05/24/2016
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Last Update Date | 12/08/2020
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Provider Practice Location Address
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Address Line | 2206 STATE ST SUITE 300
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City | NEW ALBANY
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State | IN
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Zip | 47150-4925
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Country | US
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Telephone | 812-206-0200
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Fax | 812-206-0002
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Provider Business Mailing Address
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Address Line | 2700 STANLEY GAULT PKWY STE 129
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City | LOUISVILLE
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State | KY
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Zip | 40223-5176
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Country | US
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Telephone | 502-253-4918
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Fax | 502-489-5751
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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