Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 2723 | SC |
NPI | 1043289499 |
---|---|
Provider Name | Ms. Jennifaye Verdina Brown |
First Address | Charleston, SC 29414-5173 |
Second Address | Charleston, SC 29414-5173 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/03/2006 |
Last Update Date | 23/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
TH1548 | (05) | SC |