Provider Demographics
NPI:1790941094
Name:BREWSTER, AMANDA JEAN (PT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:JEAN
Last Name:BREWSTER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1511 BEAR POND RD
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04220-5508
Mailing Address - Country:US
Mailing Address - Phone:207-224-7173
Mailing Address - Fax:
Practice Address - Street 1:1511 BEAR POND RD
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:ME
Practice Address - Zip Code:04220-5508
Practice Address - Country:US
Practice Address - Phone:207-224-7173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-06
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT2762225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist