Provider Demographics
NPI:1588855001
Name:BROWN, RAE-ANNE (PT)
Entity Type:Individual
Prefix:
First Name:RAE-ANNE
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 1:703 RAVENSWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-3117
Mailing Address - Country:US
Mailing Address - Phone:609-652-3774
Mailing Address - Fax:
Practice Address - Street 1:18 E JIMMIE LEEDS RD
Practice Address - Street 2:SUITE B
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-9510
Practice Address - Country:US
Practice Address - Phone:609-652-3774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-08
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01034700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist