MEDICARE: MR. TERRENCE MICHAEL BROWN PTA

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	225200000X	Physical Therapy Assistant	AT2530	CA

General Provider Information

NPI Number	:	1508137043
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TERRENCE MICHAEL BROWN PTA

Provider Business Mailing Address
First Line	:	11851 FORTNEY DR
Second Line	:
City	:	ANAHEIM
State	:	CA
Zip	:	92804-6724
Country	:	US
Telephone Number	:	714-638-1531
Fax Number	:	714-638-1531

Provider Business Practice Location Address
First Line	:	2040 S EUCLID ST
Second Line	:
City	:	ANAHEIM
State	:	CA
Zip	:	92802-3111
Country	:	US
Telephone Number	:	714-636-2800
Fax Number	:

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

Provider Enumeration Date	:	01/14/2012
Last Update Date	:	01/14/2012

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