Healthcare Provider Details

I. General information

NPI: 1144907890
Provider Name (Legal Business Name): AUSTIN BREWER PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2023
Last Update Date: 07/03/2023
Certification Date: 06/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3198 US-60 SUITE A
ONA WV
25545
US

IV. Provider business mailing address

3198 US 60 SUITE A ONA, WV
ONA WV
25545
US

V. Phone/Fax

Practice location:
  • Phone: 304-733-9430
  • Fax:
Mailing address:
  • Phone: 304-733-9430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number002447
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: