Provider Demographics
NPI:1528214038
Name:BREWER, SCOTT MICHAEL (MS, ATC/L, PTA)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:MICHAEL
Last Name:BREWER
Suffix:
Gender:M
Credentials:MS, ATC/L, PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10400 READING RD
Mailing Address - Street 2:STE. 105
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45241-4816
Mailing Address - Country:US
Mailing Address - Phone:513-733-3370
Mailing Address - Fax:513-786-7893
Practice Address - Street 1:10400 READING RD
Practice Address - Street 2:STE. 105
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45241-4816
Practice Address - Country:US
Practice Address - Phone:513-733-3370
Practice Address - Fax:513-786-7893
Is Sole Proprietor?:No
Enumeration Date:2008-08-15
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPTA07004225200000X
OHAT0021522255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer