Provider Demographics
NPI:1558328468
Name:BROWN, JAMES W (PT)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:W
Last Name:BROWN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5851 LANCEFIELD DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92649-4904
Mailing Address - Country:US
Mailing Address - Phone:760-218-1400
Mailing Address - Fax:714-840-3694
Practice Address - Street 1:13071 BROOKHURST ST
Practice Address - Street 2:SUITE 110
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-1091
Practice Address - Country:US
Practice Address - Phone:714-636-7410
Practice Address - Fax:714-636-6874
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT5873225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHM118AOtherPTAN
CABS01000040OtherSMMITTER #