MEDICARE: MRS. BROOKS E BREWER PT

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
1	174400000X	Specialist	PT2801	AR
2	225100000X	Physical Therapist	PT2801	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5Y229	OTHER	AR	BLUECROSS PROVIDER #
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740247642
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BROOKS E BREWER PT

Provider Business Mailing Address
First Line	:	111 HOLLYWOOD AVE
Second Line	:
City	:	HOT SPRINGS
State	:	AR
Zip	:	71901-7058
Country	:	US
Telephone Number	:	501-321-2700
Fax Number	:	501-321-2701

Provider Business Practice Location Address
First Line	:	111 HOLLYWOOD AVE
Second Line	:
City	:	HOT SPRINGS
State	:	AR
Zip	:	71901-7058
Country	:	US
Telephone Number	:	501-321-2700
Fax Number	:	501-321-2701

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/26/2006
Last Update Date	:	09/09/2024

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