Individual provider Active NPI

Declan Brown, PT, DPT

  • Physical Therapist
  • Georgetown, IN
National Provider Identifier
1235969882
Registry record updated Aug 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
05015656A Issued in IN
Practice address
1050 Copperfield Dr
Georgetown, IN 47122-9075
Phone
(812) 951-1440
NPI assigned
Aug 7, 2024
Last updated
Aug 7, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 7, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 05015656A IN Primary

Addresses

Primary practice location

1050 Copperfield Dr
Georgetown, IN 47122-9075

Mailing address

3303 Protege PL Unit 303
Louisville, KY 40245-7737
Phone (502) 644-8569

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240821003737 IN Practitioner - Physical Therapist in Private Practice 7416495494 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
SN Kentuckiana Rehab, LLCGroup PAC ID 1254671464, 339 clinicians

Practice addresses (Care Compare)

1050 Copperfield Dr
Georgetown, IN 47122-9075
Phone (812) 951-1440

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
05015656AINMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
SN Kentuckiana Rehab, LLC Current Accepting new patients
SN Kentuckiana Rehab, LLC CurrentSince Jun 15, 2024 Accepting new patients
SN Kentuckiana Rehab, LLC CurrentSince Jun 15, 2024 Accepting new patients

Locations

325 E Lewis and Clark Pkwy
Ste 100
Clarksville, IN 47129
Phone (812) 283-3231

1050 Copperfield Dr
Georgetown, IN 47122
Phone (502) 499-0107

1730 Williamsburg Dr
Ste 3
Jeffersonvlle, IN 47130
Phone (812) 246-0705

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1722988800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722988800000",
    "number": "1235969882",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3303 PROTEGE PL UNIT 303",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402457737",
            "telephone_number": "502-644-8569"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1050 COPPERFIELD DR",
            "city": "GEORGETOWN",
            "state": "IN",
            "postal_code": "471229075",
            "telephone_number": "812-951-1440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROWN",
        "first_name": "DECLAN",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-08-07",
        "last_updated": "2024-08-07",
        "certification_date": "2024-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IN",
            "license": "05015656A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Georgetown, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.