Provider Demographics
NPI:1689797649
Name:BREWER, BOBBY (BJ) JAMES (PT ASST)
Entity Type:Individual
Prefix:
First Name:BOBBY (BJ)
Middle Name:JAMES
Last Name:BREWER
Suffix:
Gender:M
Credentials:PT ASST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4107 WAVERLY RD
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:TX
Mailing Address - Zip Code:76208-5269
Mailing Address - Country:US
Mailing Address - Phone:940-453-1319
Mailing Address - Fax:
Practice Address - Street 1:2620 SCRIPTURE ST
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-4315
Practice Address - Country:US
Practice Address - Phone:940-297-6500
Practice Address - Fax:972-297-6535
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2011-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2052410225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant