Healthcare Provider Details

I. General information

NPI: 1750847067
Provider Name (Legal Business Name): JAMIE L BROWN PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2019
Last Update Date: 02/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 FORT JESSE RD STE 230
NORMAL IL
61761-6291
US

IV. Provider business mailing address

11 8TH DR
DECATUR IL
62521-5472
US

V. Phone/Fax

Practice location:
  • Phone: 309-661-6260
  • Fax:
Mailing address:
  • Phone: 217-791-7733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number070023890
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: