Provider Demographics
NPI:1710149232
Name:BREWERTON, NATHAN JOHN (LPT)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:JOHN
Last Name:BREWERTON
Suffix:
Gender:M
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 HIGHWAY 71 W
Mailing Address - Street 2:SUITE 106
Mailing Address - City:BASTROP
Mailing Address - State:TX
Mailing Address - Zip Code:78602-4105
Mailing Address - Country:US
Mailing Address - Phone:512-321-9659
Mailing Address - Fax:
Practice Address - Street 1:301 HIGHWAY 71 W
Practice Address - Street 2:SUITE 106
Practice Address - City:BASTROP
Practice Address - State:TX
Practice Address - Zip Code:78602-4105
Practice Address - Country:US
Practice Address - Phone:512-321-9659
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-26
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1181012225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist