Healthcare Provider Details

I. General information

NPI: 1033609524
Provider Name (Legal Business Name): CARLEY BROWN BEROLZHEIMER PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CARLEY JACLYN BROWN PT

II. Dates (important events)

Enumeration Date: 05/10/2018
Last Update Date: 11/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 W WEAVER ST UNIT 104
CARRBORO NC
27510-2083
US

IV. Provider business mailing address

790 REMINGTON BLVD
BOLINGBROOK IL
60440-4909
US

V. Phone/Fax

Practice location:
  • Phone: 919-942-0240
  • Fax:
Mailing address:
  • Phone: 630-296-2222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP17709
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: