MEDICARE: DR. DUSTIN ROBERT BROWN PT, DPT, ATC, LAT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	9428PT	IA
2	225100000X	Physical Therapist	070021852	IL

General Provider Information

NPI Number	:	1124306501
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DUSTIN ROBERT BROWN PT, DPT, ATC, LAT

Provider Business Mailing Address
First Line	:	625 ENTERPRISE DR
Second Line	:
City	:	OAK BROOK
State	:	IL
Zip	:	60523-8813
Country	:	US
Telephone Number	:	630-575-6200
Fax Number	:

Provider Business Practice Location Address
First Line	:	123 W SPRING CREEK RD
Second Line	:
City	:	EAST PEORIA
State	:	IL
Zip	:	61611-1346
Country	:	US
Telephone Number	:	309-282-4800
Fax Number	:	309-282-4801

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2011
Last Update Date	:	06/15/2017

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Directions to “ DR. DUSTIN ROBERT BROWN PT, DPT, ATC, LAT” Practice Location

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