Healthcare Provider Details

I. General information

NPI: 1649241779
Provider Name (Legal Business Name): JESSICA RAE BROWN DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 07/29/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

829 SW LEMANS LN
LEES SUMMIT MO
64082-4618
US

IV. Provider business mailing address

829 SW LEMANS LN
LEES SUMMIT MO
64082-4618
US

V. Phone/Fax

Practice location:
  • Phone: 816-352-9461
  • Fax: 816-817-0501
Mailing address:
  • Phone: 816-352-9461
  • Fax: 816-817-0501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPTH4618
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number7981
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: