MEDICARE: MRS. JENNIFER A BROWN

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	172M00000X	Mechanotherapist	MA60011822	WA

General Provider Information

NPI Number	:	1558690842
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER A BROWN

Provider Business Mailing Address
First Line	:	1224 S TYLER ST
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98405-1134
Country	:	US
Telephone Number	:	253-777-4284
Fax Number	:

Provider Business Practice Location Address
First Line	:	5900 100TH ST SW STE 14
Second Line	:
City	:	LAKEWOOD
State	:	WA
Zip	:	98499-2749
Country	:	US
Telephone Number	:	253-581-8456
Fax Number	:

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

Provider Enumeration Date	:	12/15/2009
Last Update Date	:	05/14/2010

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