Provider Demographics
NPI:1639115363
Name:BRASHEAR, ERNESTINE C (PT)
Entity Type:Individual
Prefix:MRS
First Name:ERNESTINE
Middle Name:C
Last Name:BRASHEAR
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3425 EXECUTIVE PKWY
Mailing Address - Street 2:SUITE 128
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-1333
Mailing Address - Country:US
Mailing Address - Phone:418-537-0764
Mailing Address - Fax:419-537-0948
Practice Address - Street 1:193 GLADES RD
Practice Address - Street 2:
Practice Address - City:BEREA
Practice Address - State:KY
Practice Address - Zip Code:40403-1369
Practice Address - Country:US
Practice Address - Phone:859-986-1055
Practice Address - Fax:859-986-1002
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY000834225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY87008348Medicaid
KY5029001Medicare ID - Type Unspecified
KY186600Medicare Oscar/Certification