Provider Demographics
NPI:1962426767
Name:BROWN, JESSICA (PT)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 SAINT VINCENT CIR STE 401
Mailing Address - Street 2:BLANFORD BUILDING
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-5413
Mailing Address - Country:US
Mailing Address - Phone:501-661-0077
Mailing Address - Fax:501-664-2749
Practice Address - Street 1:5 SAINT VINCENT CIR STE 401
Practice Address - Street 2:BLANFORD BUILDING
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5413
Practice Address - Country:US
Practice Address - Phone:501-661-0077
Practice Address - Fax:501-664-2749
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AR23512251N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARAR 2351OtherPHYSICAL THERAPY LICENSE