Healthcare Provider Details

I. General information

NPI: 1215903232
Provider Name (Legal Business Name): JAKIE BRITT BROWN ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 COWBOYS PKWY DALLAS COWBOYS
IRVING TX
75063-4924
US

IV. Provider business mailing address

325 KINGS RD
DOUBLE OAK TX
75077-3042
US

V. Phone/Fax

Practice location:
  • Phone: 972-556-9992
  • Fax: 972-556-9993
Mailing address:
  • Phone: 972-556-9992
  • Fax: 972-556-9993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT0957
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: