Healthcare Provider Details

I. General information

NPI: 1730580994
Provider Name (Legal Business Name): JESSICA A BROWN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA A GREEN PT

II. Dates (important events)

Enumeration Date: 09/08/2014
Last Update Date: 09/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 W RUN RD
MUNHALL PA
15120-2869
US

IV. Provider business mailing address

2600 W RUN RD
MUNHALL PA
15120-2869
US

V. Phone/Fax

Practice location:
  • Phone: 412-462-8002
  • Fax: 412-462-2113
Mailing address:
  • Phone: 412-462-8002
  • Fax: 412-462-2113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT023604
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: