MEDICARE: MAHITHA REDDY BROWN DPT, ATC, NCPT

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	40QA01980600	NJ

General Provider Information

NPI Number	:	1770037780
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAHITHA REDDY BROWN DPT, ATC, NCPT

Provider Business Mailing Address
First Line	:	160 SUMMIT AVE STE 204
Second Line	:
City	:	MONTVALE
State	:	NJ
Zip	:	07645-1763
Country	:	US
Telephone Number	:	201-305-0130
Fax Number	:

Provider Business Practice Location Address
First Line	:	160 SUMMIT AVE STE 204
Second Line	:
City	:	MONTVALE
State	:	NJ
Zip	:	07645-1763
Country	:	US
Telephone Number	:	201-305-0130
Fax Number	:

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

Provider Enumeration Date	:	08/08/2016
Last Update Date	:	04/13/2023

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