Provider Demographics
NPI:1730604307
Name:BROWN, JEREMY (DPT)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:
Last Name:BROWN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:646 GEORGE ST
Mailing Address - Street 2:
Mailing Address - City:CLARE
Mailing Address - State:MI
Mailing Address - Zip Code:48617-9413
Mailing Address - Country:US
Mailing Address - Phone:989-424-6300
Mailing Address - Fax:989-424-6302
Practice Address - Street 1:24165 W INTERSTATE 10 STE 202
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78257-1160
Practice Address - Country:US
Practice Address - Phone:210-698-1919
Practice Address - Fax:210-698-6919
Is Sole Proprietor?:No
Enumeration Date:2017-08-04
Last Update Date:2017-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1293285225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1293285OtherSTATE LICENSE