Provider Demographics
NPI:1750858429
Name:BREWER, LYNNZ MORGYNN (DPT, ATC)
Entity type:Individual
Prefix:DR
First Name:LYNNZ
Middle Name:MORGYNN
Last Name:BREWER
Suffix:
Gender:X
Credentials:DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 OBERLIN RD STE 302
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27605-1351
Mailing Address - Country:US
Mailing Address - Phone:803-412-9110
Mailing Address - Fax:
Practice Address - Street 1:815 OBERLIN RD STE 302
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27605-1351
Practice Address - Country:US
Practice Address - Phone:919-670-4097
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-30
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X, 2255A2300X
NCP23441225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer