Provider Demographics
NPI:1649503061
Name:BREWER, MICHELLE RAILYN (MPT)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:RAILYN
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 1:1320 18TH ST
Mailing Address - Street 2:
Mailing Address - City:ANSON
Mailing Address - State:TX
Mailing Address - Zip Code:79501-6106
Mailing Address - Country:US
Mailing Address - Phone:325-823-3041
Mailing Address - Fax:
Practice Address - Street 1:1320 18TH ST
Practice Address - Street 2:
Practice Address - City:ANSON
Practice Address - State:TX
Practice Address - Zip Code:79501-6106
Practice Address - Country:US
Practice Address - Phone:325-823-3041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-16
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1132868225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist