Provider Demographics
NPI:1659690055
Name:BREWSTER, EDWARD R (LMT)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:R
Last Name:BREWSTER
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 W ELM ST
Mailing Address - Street 2:APARTMENT 2
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33604-5463
Mailing Address - Country:US
Mailing Address - Phone:813-401-5808
Mailing Address - Fax:
Practice Address - Street 1:217 W ELM ST
Practice Address - Street 2:APARTMENT 2
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33604-5463
Practice Address - Country:US
Practice Address - Phone:813-401-5808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-25
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA59030225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist