Provider Demographics
NPI:1588391379
Name:BROWN, NATHANIEL ALAN (DPT)
Entity type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:ALAN
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 1:124 SAWYER BRIDGE TRL
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA
Mailing Address - State:FL
Mailing Address - Zip Code:32081-1218
Mailing Address - Country:US
Mailing Address - Phone:321-591-0907
Mailing Address - Fax:
Practice Address - Street 1:124 SAWYER BRIDGE TRL
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA
Practice Address - State:FL
Practice Address - Zip Code:32081-1218
Practice Address - Country:US
Practice Address - Phone:321-591-0907
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-02
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT28545261QP2000X, 261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy