Basic Information
| Provider Information | |||||||||
| NPI: | 1285690545 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BROWN | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | CRAIG | ||||||||
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| Credential: | P.T., A.T.C, S.C.S | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5924 | ||||||||
| Address2: | |||||||||
| City: | CAREFREE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853775924 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4804889095 | ||||||||
| FaxNumber: | 4804882862 | ||||||||
| Practice Location | |||||||||
| Address1: | 18444 N 25TH AVE | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850231261 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6235375600 | ||||||||
| FaxNumber: | 8669392673 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2006 | ||||||||
| LastUpdateDate: | 01/17/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 0726 | AZ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 146457 | 05 | AZ | MEDICAID | Z101161 | 01 | AZ | MEDICARE | OTHER |