=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871710814
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LARRY BROWN D/B/A COAST PHYSICAL THERAPY SPEC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/19/2007
-----------------------------------------------------
Last Update Date | 04/24/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1701 SOLAR DR STE. 155
-----------------------------------------------------
City | OXNARD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93030-0134
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-604-4644
-----------------------------------------------------
Fax | 805-604-4434
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1701 SOLAR DR STE. 155
-----------------------------------------------------
City | OXNARD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93030-0134
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-604-4644
-----------------------------------------------------
Fax | 805-604-4434
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. LARRY PATRICK BROWN
-----------------------------------------------------
Credential | PT
-----------------------------------------------------
Telephone | 805-604-4644
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 07-00073195
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------