Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251S0007X | Physical Therapist - Sports | 18533 | NC |
Y | 2251X0800X | Physical Therapist - Orthopedic | 18533 | NC |
NPI | 1205392750 |
---|---|
Provider Name | Dr. Campbell Brown |
First Address | Raleigh, NC 27609-7300 |
Second Address | Raleigh, NC 27609-7300 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2019 |
Last Update Date | 20/02/2019 |