Jodi Ann Brown, PT
Individual provider Active NPI Physical Therapist · Grand Haven, MI
NPI 1639650658 · NPPES record last updated Nov 7, 2018
Key facts
- NPI
- 1639650658
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 5501010670 (MI)
- Practice address
- 15100 Whittaker Way
Grand Haven, MI 49417-8696 - Phone
- (616) 935-6280
- NPI assigned
- Aug 27, 2018
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20181106002142 | MI | Practitioner - Physical Therapist in Private Practice | 9436403631 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5501010670 | MI | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ivyrehab Michigan, LLC | Physical Therapist | Current |
Accepting new patients |
Locations
135 S Milford Rd
Milford, MI 48381
Phone (248) 685-7272
1910 E Apple Ave
Ste H
Muskegon, MI 49442
Phone (231) 333-9148
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 5501010670 | MI | Yes |
Addresses
Primary practice location
15100 Whittaker Way
Grand Haven, MI 49417-8696
Mailing address
100 Michigan St NE # Mc845
Grand Rapids, MI 49503-2560
Other providers in Grand Haven, MI
- Carrie Brondyke
- Brandi Sue Brower
- Christina Lee Brown
- Christina Marie Brown
- Ellen Brown
- Kayla Marie Brown
- Nicole Brown
- Sarah Brown
- Stephanie Nichole Brown
- Stephen M Brown
All providers in Grand Haven, MI · Physical Therapist in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 7, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.