Provider Demographics
NPI:1336613207
Name:BREWER, LORI F (LMT)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:F
Last Name:BREWER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:ASHA-LORI
Other - Middle Name:F
Other - Last Name:BREWER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:7447 S SOUTH SHORE DR APT 27D
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60649-3867
Mailing Address - Country:US
Mailing Address - Phone:773-610-7348
Mailing Address - Fax:
Practice Address - Street 1:7447 S SOUTH SHORE DR APT 27D
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60649-3867
Practice Address - Country:US
Practice Address - Phone:773-610-7348
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-14
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227-005067225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty