Provider Demographics
NPI:1245977990
Name:BROWN, JARED ROGER (DPT)
Entity type:Individual
Prefix:
First Name:JARED
Middle Name:ROGER
Last Name:BROWN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 PARKVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-4062
Mailing Address - Country:US
Mailing Address - Phone:207-812-8802
Mailing Address - Fax:
Practice Address - Street 1:43490 YUKON DR STE 212
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-7326
Practice Address - Country:US
Practice Address - Phone:703-729-7920
Practice Address - Fax:703-729-7923
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-15
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT6217225100000X
VA2305215215225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist