Healthcare Provider Details

I. General information

NPI: 1043289499
Provider Name (Legal Business Name): JENNIFAYE VERDINA BROWN PT, PHD, NCS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENNIFAYE VERDINA GREENE PT, MS, NCS

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 08/23/2021
Certification Date: 08/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 BONIETA HARROLD DRIVE #8102
CHARLESTON SC
29414-5173
US

IV. Provider business mailing address

1000 BONIETA HARROLD DRIVE #8102
CHARLESTON SC
29414-5173
US

V. Phone/Fax

Practice location:
  • Phone: 843-364-5089
  • Fax: 843-763-0229
Mailing address:
  • Phone: 843-364-5089
  • Fax: 843-763-0229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number2723
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: