Basic Information
| Provider Information | |||||||||
| NPI: | 1972166965 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BROWN | ||||||||
| FirstName: | KALEB | ||||||||
| MiddleName: | JARRETT | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1300 W SAM HOUSTON PKWY S STE 300 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770422453 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7132976792 | ||||||||
| FaxNumber: | 7134304041 | ||||||||
| Practice Location | |||||||||
| Address1: | 1415 COMMERCE DR STE A | ||||||||
| Address2: | |||||||||
| City: | POCAHONTAS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 724551495 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8702480800 | ||||||||
| FaxNumber: | 8702480802 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/16/2019 | ||||||||
| LastUpdateDate: | 04/16/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT4305 | AR | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.