Provider Demographics
NPI:1245608884
Name:BROWN, JANAE NICOLE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JANAE
Middle Name:NICOLE
Last Name:BROWN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:DR
Other - First Name:JANAE
Other - Middle Name:
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:481 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90731-2631
Mailing Address - Country:US
Mailing Address - Phone:424-536-3023
Mailing Address - Fax:424-536-3023
Practice Address - Street 1:481 W 6TH ST
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731-2631
Practice Address - Country:US
Practice Address - Phone:424-536-3023
Practice Address - Fax:424-536-3023
Is Sole Proprietor?:No
Enumeration Date:2015-09-14
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT32360225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT32360OtherPHYSICAL THERAPY BOARD OF CA