=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962976258
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOCELYN DAPRICE BROWN PT, DPT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/19/2019
-----------------------------------------------------
Last Update Date | 12/05/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 765 N HAMILTON RD
-----------------------------------------------------
City | GAHANNA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43230-8703
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-968-7278
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2408 PEARSON WAY
-----------------------------------------------------
City | HILLIARD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43026-7767
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT017791
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------