MEDICARE: JESS BROWN PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT870705	DC
2	225100000X	Physical Therapist	070015935	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	567700	OTHER	IL	MEDICARE GROUP NUMBER
2	568150	OTHER	IL	MEDICARE GROUP NUMBER

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	1619908	OTHER	IL	BCBS IL GROUP

General Provider Information

NPI Number	:	1003971300
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESS BROWN PT

Provider Business Mailing Address
First Line	:	205 W WACKER DR
Second Line	:	SUITE 1020
City	:	CHICAGO
State	:	IL
Zip	:	60606-1216
Country	:	US
Telephone Number	:	312-640-0329
Fax Number	:

Provider Business Practice Location Address
First Line	:	1156 W LAKE COOK RD
Second Line	:
City	:	BUFFALO GROVE
State	:	IL
Zip	:	60089-1979
Country	:	US
Telephone Number	:	847-520-7264
Fax Number	:	847-520-7290

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/27/2006
Last Update Date	:	11/26/2008

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Directions to “ JESS BROWN PT” Practice Location

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