Provider Demographics
NPI:1073620423
Name:BREWER, FRANKIE (PT)
Entity Type:Individual
Prefix:
First Name:FRANKIE
Middle Name:
Last Name:BREWER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ANTLERS
Mailing Address - State:OK
Mailing Address - Zip Code:74523-2087
Mailing Address - Country:US
Mailing Address - Phone:580-298-9818
Mailing Address - Fax:580-298-9822
Practice Address - Street 1:402 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ANTLERS
Practice Address - State:OK
Practice Address - Zip Code:74523-2087
Practice Address - Country:US
Practice Address - Phone:580-298-9818
Practice Address - Fax:580-298-9822
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2009-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1681OtherLICENSE #