Provider Demographics
NPI:1225741390
Name:BREWER, BRYAN D (PTA)
Entity Type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:D
Last Name:BREWER
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3123 CREEKWOOD CT
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-3305
Mailing Address - Country:US
Mailing Address - Phone:405-397-0808
Mailing Address - Fax:
Practice Address - Street 1:3123 CREEKWOOD CT
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-3305
Practice Address - Country:US
Practice Address - Phone:405-397-0808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-03
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK761225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant