Healthcare Provider Details

I. General information

NPI: 1962426767
Provider Name (Legal Business Name): JESSICA BROWN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 SAINT VINCENT CIR STE 401 BLANFORD BUILDING
LITTLE ROCK AR
72205-5413
US

IV. Provider business mailing address

5 SAINT VINCENT CIR STE 401 BLANFORD BUILDING
LITTLE ROCK AR
72205-5413
US

V. Phone/Fax

Practice location:
  • Phone: 501-661-0077
  • Fax: 501-664-2749
Mailing address:
  • Phone: 501-661-0077
  • Fax: 501-664-2749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number2351
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: