Provider Demographics
NPI:1871710814
Name:LARRY BROWN D/B/A COAST PHYSICAL THERAPY SPEC
Entity type:Organization
Organization Name:LARRY BROWN D/B/A COAST PHYSICAL THERAPY SPEC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:805-604-4644
Mailing Address - Street 1:1701 SOLAR DR
Mailing Address - Street 2:STE. 155
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93030-0134
Mailing Address - Country:US
Mailing Address - Phone:805-604-4644
Mailing Address - Fax:805-604-4434
Practice Address - Street 1:1701 SOLAR DR
Practice Address - Street 2:STE. 155
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-0134
Practice Address - Country:US
Practice Address - Phone:805-604-4644
Practice Address - Fax:805-604-4434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2012-04-24
Deactivation Date:2008-08-12
Deactivation Code:
Reactivation Date:2012-04-24
Provider Licenses
StateLicense IDTaxonomies
CA07-00073195174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty