Provider Demographics
NPI:1649241779
Name:BROWN, JESSICA RAE (DPT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:RAE
Last Name:BROWN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 PALMETTO BLUFF DR
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29418-3018
Mailing Address - Country:US
Mailing Address - Phone:912-398-4554
Mailing Address - Fax:
Practice Address - Street 1:2070 NORTHBROOK BLVD
Practice Address - Street 2:SUITE B4
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9252
Practice Address - Country:US
Practice Address - Phone:843-563-3033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC79812251P0200X
ALPTH46182251P0200X
GA2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics