Provider Demographics
NPI:1740247642
Name:BREWER, BROOKS E (PT)
Entity type:Individual
Prefix:MRS
First Name:BROOKS
Middle Name:E
Last Name:BREWER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:BROOKS
Other - Middle Name:SHEPHERD
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:111 HOLLYWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71901-7058
Mailing Address - Country:US
Mailing Address - Phone:501-321-2700
Mailing Address - Fax:501-321-2701
Practice Address - Street 1:111 HOLLYWOOD AVE
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-7058
Practice Address - Country:US
Practice Address - Phone:501-321-2700
Practice Address - Fax:501-321-2701
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT2801174400000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5Y229OtherBLUECROSS PROVIDER #
AR155606721Medicaid