Provider Demographics
NPI:1629200407
Name:BROWN, JENNIFER M (PT DPT GCS)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:M
Last Name:BROWN
Suffix:
Gender:F
Credentials:PT DPT GCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 OLD LANCASTER RD STE 12
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:PA
Mailing Address - Zip Code:19312-1671
Mailing Address - Country:US
Mailing Address - Phone:610-225-2451
Mailing Address - Fax:610-964-6166
Practice Address - Street 1:511 OLD LANCASTER RD STE 12
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:PA
Practice Address - Zip Code:19312-1671
Practice Address - Country:US
Practice Address - Phone:610-225-2451
Practice Address - Fax:610-964-6166
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-12
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA009786L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA231419YF1QOtherMEDICARE PTAN