Basic Information
| Provider Information | |||||||||
| NPI: | 1588855001 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BROWN | ||||||||
| FirstName: | RAE-ANNE | ||||||||
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| Credential: | P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 703 RAVENSWOOD DR | ||||||||
| Address2: | |||||||||
| City: | GALLOWAY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 082053117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6096523774 | ||||||||
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| Practice Location | |||||||||
| Address1: | 18 E JIMMIE LEEDS RD | ||||||||
| Address2: | SUITE B | ||||||||
| City: | GALLOWAY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 082059510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6096523774 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/08/2007 | ||||||||
| LastUpdateDate: | 08/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 40QA01034700 | NJ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.