Provider Demographics
NPI:1962526293
Name:BROWN, CARLYLE A (PT)
Entity type:Individual
Prefix:MR
First Name:CARLYLE
Middle Name:A
Last Name:BROWN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:KIM
Other - Middle Name:A
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:1492 W ANTELOPE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-1151
Mailing Address - Country:US
Mailing Address - Phone:801-825-8091
Mailing Address - Fax:801-825-8142
Practice Address - Street 1:1492 W ANTELOPE DR STE 100
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-1151
Practice Address - Country:US
Practice Address - Phone:801-825-8091
Practice Address - Fax:801-825-8142
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT108002-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist