MEDICARE: JAMES W BROWN PT

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	PT5873	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	HM118A	OTHER	CA	PTAN
2	BS01000040	OTHER	CA	SMMITTER #

General Provider Information

NPI Number	:	1558328468
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES W BROWN PT

Provider Business Mailing Address
First Line	:	5851 LANCEFIELD DR
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92649-4904
Country	:	US
Telephone Number	:	760-218-1400
Fax Number	:	714-840-3694

Provider Business Practice Location Address
First Line	:	13071 BROOKHURST ST
Second Line	:	SUITE 110
City	:	GARDEN GROVE
State	:	CA
Zip	:	92843-1091
Country	:	US
Telephone Number	:	714-636-7410
Fax Number	:	714-636-6874

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

Provider Enumeration Date	:	04/26/2006
Last Update Date	:	03/25/2014

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