Healthcare Provider Details

I. General information

NPI: 1649316530
Provider Name (Legal Business Name): MRS. JENNIFER BROOKE BRICKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 WILSON LOOP ROAD
WARD AR
72176
US

IV. Provider business mailing address

4538 EDGEMERE ST
NORTH LITTLE ROCK AR
72116-7466
US

V. Phone/Fax

Practice location:
  • Phone: 501-941-5630
  • Fax:
Mailing address:
  • Phone: 501-838-9527
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT2582
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: