Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics |
NPI | 1033773510 |
---|---|
Provider Name | Jada Brown |
First Address | Washington, DC 20012-1960 |
Second Address | Washington, DC 20012-1960 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/04/2019 |
Last Update Date | 16/07/2020 |