Provider Demographics
NPI:1093913055
Name:BREWER, JOLENA LEIGH (LMT, CNMT)
Entity Type:Individual
Prefix:
First Name:JOLENA
Middle Name:LEIGH
Last Name:BREWER
Suffix:
Gender:F
Credentials:LMT, CNMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 CHEYENNE ST
Mailing Address - Street 2:
Mailing Address - City:CALHAN
Mailing Address - State:CO
Mailing Address - Zip Code:80808-8425
Mailing Address - Country:US
Mailing Address - Phone:719-339-6761
Mailing Address - Fax:
Practice Address - Street 1:5865 LEHMAN DR
Practice Address - Street 2:SUITE 100
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-3422
Practice Address - Country:US
Practice Address - Phone:719-339-6761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist