MEDICARE: DR. KEENAN DAVID BROWN PT, DPT

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	2305212950	VA
2	2251X0800X	Orthopedic Physical Therapist

General Provider Information

NPI Number	:	1629620349
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEENAN DAVID BROWN PT, DPT

Provider Business Mailing Address
First Line	:	1115 BOULDERS PKWY STE 200
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23225-4067
Country	:	US
Telephone Number	:	804-327-9242
Fax Number	:	804-327-9812

Provider Business Practice Location Address
First Line	:	1920 BALLENGER AVE STE 200
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22314-6818
Country	:	US
Telephone Number	:	703-810-5284
Fax Number	:	703-810-5465

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

Provider Enumeration Date	:	07/12/2019
Last Update Date	:	02/04/2022

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