Provider Demographics
NPI:1124430699
Name:BROWN, DANIEL (DPT)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:BROWN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3195 PEARL PKWY APT 405
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-2473
Mailing Address - Country:US
Mailing Address - Phone:502-320-6784
Mailing Address - Fax:502-308-4628
Practice Address - Street 1:1650 38TH ST STE 100E
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-2624
Practice Address - Country:US
Practice Address - Phone:502-320-6784
Practice Address - Fax:502-308-4628
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-02
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10140225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist