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General NPI Number Information
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NPI Number | 1942181995
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Entity Type | Individual
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Provider Name | DEREK ANDREW BREWSTER LMT, CMLDT
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Gender | Male
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Dates
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Enumeration Date | 09/08/2025
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Last Update Date | 09/08/2025
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Provider Practice Location Address
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Address Line | 2202 E 49TH ST STE 520
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City | TULSA
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State | OK
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Zip | 74105-8710
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Country | US
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Telephone | 918-821-7015
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Fax |
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Provider Business Mailing Address
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Address Line | 4801 S ELM PL APT 922
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City | BROKEN ARROW
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State | OK
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Zip | 74011-4868
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 203805
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License Number State | OK
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