Healthcare Provider Details

I. General information

NPI: 1750299301
Provider Name (Legal Business Name): I'KIA BREWTON
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 HIDDEN LAKE DR APT 142
SANFORD FL
32773-5518
US

IV. Provider business mailing address

90 HIDDEN LAKE DR APT 142
SANFORD FL
32773-5518
US

V. Phone/Fax

Practice location:
  • Phone: 321-947-5382
  • Fax:
Mailing address:
  • Phone: 321-947-5382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTA34897
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: