Provider Demographics
NPI:1417156712
Name:BROWN, JENNIFER FAULK (PT, DPT)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:FAULK
Last Name:BROWN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 E CEDAR ST FL 4
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29506-2576
Mailing Address - Country:US
Mailing Address - Phone:843-661-3426
Mailing Address - Fax:843-661-3599
Practice Address - Street 1:121 E CEDAR ST FL 4
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-2576
Practice Address - Country:US
Practice Address - Phone:843-661-3426
Practice Address - Fax:843-661-3599
Is Sole Proprietor?:No
Enumeration Date:2007-07-16
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4872225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist