Provider Demographics
NPI:1871632695
Name:BREWER, LYNN H (MPT)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:H
Last Name:BREWER
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5252 LYNGATE CT
Mailing Address - Street 2:#203
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-1672
Mailing Address - Country:US
Mailing Address - Phone:703-239-2310
Mailing Address - Fax:703-239-2311
Practice Address - Street 1:604 SOLAREX CT
Practice Address - Street 2:SUITE 104
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21703-7005
Practice Address - Country:US
Practice Address - Phone:301-662-9335
Practice Address - Fax:301-662-9337
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20469225100000X
VA2305205223225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
8825 - 0004OtherCAREFIRST