Provider Demographics
NPI:1346372489
Name:BROWN, JADINE L (MPT)
Entity Type:Individual
Prefix:MRS
First Name:JADINE
Middle Name:L
Last Name:BROWN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:MS
Other - First Name:JADINE
Other - Middle Name:L
Other - Last Name:JARIT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:239 UPPER KIMO DR
Mailing Address - Street 2:
Mailing Address - City:KULA
Mailing Address - State:HI
Mailing Address - Zip Code:96790-8052
Mailing Address - Country:US
Mailing Address - Phone:808-344-1740
Mailing Address - Fax:808-244-3411
Practice Address - Street 1:99 S MARKET ST
Practice Address - Street 2:STE. 104
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-2200
Practice Address - Country:US
Practice Address - Phone:808-244-3440
Practice Address - Fax:808-244-3411
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI2028225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI23701-6OtherHMSA
HI54988Medicare ID - Type Unspecified