Provider Demographics
NPI:1043065857
Name:BROWN, JENNETTE (CMT, LMT, MMT)
Entity type:Individual
Prefix:
First Name:JENNETTE
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:CMT, LMT, MMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 DENBIGH BLVD
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23608-4485
Mailing Address - Country:US
Mailing Address - Phone:757-560-7488
Mailing Address - Fax:
Practice Address - Street 1:640 DENBIGH BLVD
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23608-4485
Practice Address - Country:US
Practice Address - Phone:757-560-7488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-23
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019015140225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist