Provider Demographics
NPI:1477709681
Name:BREWER PHYSICAL THERAPY & ASSOCIATES LLC
Entity Type:Organization
Organization Name:BREWER PHYSICAL THERAPY & ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:TREKELL
Authorized Official - Last Name:BREWER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:318-222-8892
Mailing Address - Street 1:663 JORDAN ST
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101-4748
Mailing Address - Country:US
Mailing Address - Phone:318-222-8892
Mailing Address - Fax:318-222-8893
Practice Address - Street 1:663 JORDAN ST
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4748
Practice Address - Country:US
Practice Address - Phone:318-222-8892
Practice Address - Fax:318-222-8893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-07
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA06887261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy