Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT 43445 | CA |
N | 2251S0007X | Physical Therapist - Sports | PT 43445 | CA |
N | 2251X0800X | Physical Therapist - Orthopedic | PT 43445 | CA |
NPI | 1285090134 |
---|---|
Provider Name | Brandon Downs |
First Address | Ventura, CA 93003-4254 |
Second Address | Ventura, CA 93003-4254 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/01/2016 |
Last Update Date | 28/07/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
056608 | MEDICARE (01) | CA |