Basic Information
| Provider Information | |||||||||
| NPI: | 1629200407 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BROWN | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PT DPT GCS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 511 OLD LANCASTER RD STE 12 | ||||||||
| Address2: | |||||||||
| City: | BERWYN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193121671 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6102252451 | ||||||||
| FaxNumber: | 6109646166 | ||||||||
| Practice Location | |||||||||
| Address1: | 511 OLD LANCASTER RD STE 12 | ||||||||
| Address2: | |||||||||
| City: | BERWYN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193121671 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6102252451 | ||||||||
| FaxNumber: | 6109646166 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/12/2009 | ||||||||
| LastUpdateDate: | 08/05/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 009786L | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 231419YF1Q | 01 | PA | MEDICARE PTAN | OTHER |