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NPI Code Detail

MEDICARE: GRACE BREWER-SMITH

MEDICARE: GRACE BREWER-SMITH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical TherapistPT00003651WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1PT00003651OTHERWALICENSE

General Provider Information

NPI Number : 1346398906
Entity Type Code : Individual
Provider Name (Legal Business Name) : GRACE BREWER-SMITH
Provider Business Mailing Address
First Line : 4833 TUMWATER VALLEY DR SE STE 150
Second Line :
City : TUMWATER
State : WA
Zip : 98501-4583
Country : US
Telephone Number : 360-493-4160
Fax Number :
Provider Business Practice Location Address
First Line : 4833 TUMWATER VALLEY DR SE STE 150
Second Line :
City : TUMWATER
State : WA
Zip : 98501-4583
Country : US
Telephone Number : 360-493-4160
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/08/2007
Last Update Date : 07/08/2007

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Directions to “ GRACE BREWER-SMITH ” Practice Location

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