Provider Demographics
NPI:1043289499
Name:BROWN, JENNIFAYE VERDINA (PT, PHD, NCS)
Entity Type:Individual
Prefix:MS
First Name:JENNIFAYE
Middle Name:VERDINA
Last Name:BROWN
Suffix:
Gender:F
Credentials:PT, PHD, NCS
Other - Prefix:MRS
Other - First Name:JENNIFAYE
Other - Middle Name:VERDINA
Other - Last Name:GREENE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, MS, NCS
Mailing Address - Street 1:1000 BONIETA HARROLD DRIVE
Mailing Address - Street 2:#8102
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-5173
Mailing Address - Country:US
Mailing Address - Phone:843-364-5089
Mailing Address - Fax:843-763-0229
Practice Address - Street 1:1000 BONIETA HARROLD DRIVE
Practice Address - Street 2:#8102
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-5173
Practice Address - Country:US
Practice Address - Phone:843-364-5089
Practice Address - Fax:843-763-0229
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-17
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC27232251N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCTH1548Medicaid
SCTH1548Medicaid