Provider Demographics
NPI:1528014479
Name:BROWN, JANE (PT)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 564
Mailing Address - Street 2:
Mailing Address - City:CRESTON
Mailing Address - State:IA
Mailing Address - Zip Code:50801-0564
Mailing Address - Country:US
Mailing Address - Phone:641-782-5052
Mailing Address - Fax:641-782-5721
Practice Address - Street 1:408 E TAYLOR ST
Practice Address - Street 2:
Practice Address - City:CRESTON
Practice Address - State:IA
Practice Address - Zip Code:50801-3958
Practice Address - Country:US
Practice Address - Phone:641-782-8151
Practice Address - Fax:641-782-5721
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00474225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1528014479Medicaid
650015146OtherRR MEDICARE
IA1528014479Medicaid
I6968Medicare ID - Type UnspecifiedMEDICARE NONBILLING #