Provider Demographics
NPI:1114495751
Name:BROWNSBERGER, JARROD CHARLES (DPT)
Entity Type:Individual
Prefix:MR
First Name:JARROD
Middle Name:CHARLES
Last Name:BROWNSBERGER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 S 18TH AVE
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-3342
Mailing Address - Country:US
Mailing Address - Phone:208-317-9841
Mailing Address - Fax:
Practice Address - Street 1:4922 YELLOWSTONE AVE STE J
Practice Address - Street 2:
Practice Address - City:CHUBBUCK
Practice Address - State:ID
Practice Address - Zip Code:83202-2360
Practice Address - Country:US
Practice Address - Phone:208-237-1882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-12
Last Update Date:2018-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT5030261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy