Healthcare Provider Details

I. General information

NPI: 1639115363
Provider Name (Legal Business Name): ERNESTINE C BRASHEAR PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 09/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

193 GLADES RD
BEREA KY
40403-1369
US

IV. Provider business mailing address

3425 EXECUTIVE PKWY SUITE 128
TOLEDO OH
43606-1333
US

V. Phone/Fax

Practice location:
  • Phone: 859-986-1055
  • Fax: 859-986-1002
Mailing address:
  • Phone: 418-537-0764
  • Fax: 419-537-0948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number000834
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: