Healthcare Provider Details

I. General information

NPI: 1417163551
Provider Name (Legal Business Name): KATHERINE ANN BREWER PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 09/21/2022
Certification Date: 09/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

W289N6369 BLACKHAWK DR
HARTLAND WI
53029-9448
US

IV. Provider business mailing address

W289N6369 BLACKHAWK DR
HARTLAND WI
53029-9448
US

V. Phone/Fax

Practice location:
  • Phone: 262-367-0837
  • Fax:
Mailing address:
  • Phone: 262-367-0837
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number6053-024
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: