Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | J10000429 | DE |
N | 2251G0304X | Physical Therapist - Geriatrics | J10000429 | DE |
Y | 2251S0007X | Physical Therapist - Sports | J10000429 | DE |
N | 2251X0800X | Physical Therapist - Orthopedic | J10000429 | DE |
NPI | 1114980877 |
---|---|
Provider Name | Glenn Brown |
First Address | Dover, DE 19901-4407 |
Second Address | Dover, DE 19901-6932 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2006 |
Last Update Date | 20/06/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0525769000 | AMERIHEALTH (01) | DE |
0525769000 | IBC AMERIHEALTH (01) | |
1114980877 | (05) | DE |
1114980877 | TRICARE (01) | |
146729900 | DEPART OF LABOR (01) | DE |
5070-0076 | GHMSI (01) | |
521729459 | BLUE CROSS BLUE SHIELD (01) | DE |
88760519 | BC MD (01) | |
CE9861 | RAILROAD MEDICARE (01) | DE |
R25330 | (02) | DE |