Provider Demographics
NPI:1295729804
Name:BREWER, YVONNE BERGEON (MPT)
Entity type:Individual
Prefix:
First Name:YVONNE
Middle Name:BERGEON
Last Name:BREWER
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:YVONNE
Other - Middle Name:MARIE
Other - Last Name:BERGEON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:27432 ALISO CREEK RD
Mailing Address - Street 2:STE 100
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-5337
Mailing Address - Country:US
Mailing Address - Phone:949-448-0872
Mailing Address - Fax:949-448-0984
Practice Address - Street 1:27432 ALISO CREEK RD
Practice Address - Street 2:STE 100
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-5337
Practice Address - Country:US
Practice Address - Phone:949-448-0872
Practice Address - Fax:949-448-0984
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT25894225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT25894DMedicare PIN