Healthcare Provider Details

I. General information

NPI: 1477221158
Provider Name (Legal Business Name): RACHAEL LYNN BREWER PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2021
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2499 PALM ST STE 200
CANTON GA
30115-8630
US

IV. Provider business mailing address

241 JEFFERSON AVE
CANTON GA
30114-7549
US

V. Phone/Fax

Practice location:
  • Phone: 770-322-4028
  • Fax: 470-523-2650
Mailing address:
  • Phone: 770-322-4028
  • Fax: 470-523-2650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT015445
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: