Provider Demographics
NPI:1285889253
Name:BROWN, JENNIFER NICOLE (DPT)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:NICOLE
Last Name:BROWN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:NICOLE
Other - Last Name:WEIDGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:810 WENTWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:TORONTO
Mailing Address - State:OH
Mailing Address - Zip Code:43964-1066
Mailing Address - Country:US
Mailing Address - Phone:740-537-2876
Mailing Address - Fax:
Practice Address - Street 1:860 MAIN ST
Practice Address - Street 2:
Practice Address - City:WINTERSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43953-3870
Practice Address - Country:US
Practice Address - Phone:740-264-9500
Practice Address - Fax:740-266-6394
Is Sole Proprietor?:No
Enumeration Date:2008-11-18
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT019051225100000X
WVPT002737225100000X
OHPT012051225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPT012051OtherLICENSE NUMBER
PAPT019051OtherLICENSE #
WVPT002737OtherLICENSE #
PAPT019051OtherLICENSE #
OHPT012051OtherLICENSE NUMBER