Healthcare Provider Details

I. General information

NPI: 1366226391
Provider Name (Legal Business Name): BRIANA BROWN DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BRIANA MCKINNEY

II. Dates (important events)

Enumeration Date: 08/21/2023
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 SATE RD 13 STE 21
ST JOHNS FL
32259
US

IV. Provider business mailing address

123 CANAL ST STE 203
POOLER GA
31322-4104
US

V. Phone/Fax

Practice location:
  • Phone: 904-239-5715
  • Fax: 904-239-5592
Mailing address:
  • Phone: 334-655-7974
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT44619
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberPT016788
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT016788
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: