Healthcare Provider Details

I. General information

NPI: 1366111346
Provider Name (Legal Business Name): ASHLEY CLINKSCALES BREWER DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2021
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105B QUALITY LN
SENATOBIA MS
38668-2317
US

IV. Provider business mailing address

2122 YORK RD STE 300
OAK BROOK IL
60523-1925
US

V. Phone/Fax

Practice location:
  • Phone: 662-562-9977
  • Fax: 662-562-9978
Mailing address:
  • Phone: 630-575-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT7221
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: