Provider Demographics
NPI:1952564221
Name:BREWER, STACY SUE (PT)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:SUE
Last Name:BREWER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:SUE
Other - Last Name:WHIGHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3525 E. SPAULDING AVE
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81008-2208
Mailing Address - Country:US
Mailing Address - Phone:719-542-4444
Mailing Address - Fax:719-543-1990
Practice Address - Street 1:3525 E. SPAULDING AVE
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-2208
Practice Address - Country:US
Practice Address - Phone:719-542-4444
Practice Address - Fax:719-543-1990
Is Sole Proprietor?:No
Enumeration Date:2008-07-08
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0002894225100000X
IN05003254A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist