Provider Demographics
NPI:1336716349
Name:BREW, ALEC CHRISTOPHER (DPT)
Entity Type:Individual
Prefix:
First Name:ALEC
Middle Name:CHRISTOPHER
Last Name:BREW
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:866-370-8206
Mailing Address - Fax:517-435-3670
Practice Address - Street 1:2394 COSTCO WAY STE 120
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WI
Practice Address - Zip Code:54311-9226
Practice Address - Country:US
Practice Address - Phone:920-321-0348
Practice Address - Fax:920-888-4272
Is Sole Proprietor?:No
Enumeration Date:2021-06-08
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH019291225100000X
WI16421-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist