Healthcare Provider Details

I. General information

NPI: 1972950269
Provider Name (Legal Business Name): JACEY RACHEL BROWN PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2016
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12380 DE PAUL DR
BRIDGETON MO
63044-2511
US

IV. Provider business mailing address

472 FALL RIVER LN
SAINT CHARLES MO
63304-8501
US

V. Phone/Fax

Practice location:
  • Phone: 314-447-9710
  • Fax:
Mailing address:
  • Phone: 636-439-8451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2023001116
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: