Provider Demographics
NPI:1033951215
Name:BREWER, NICHOLAS T (DPT)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:T
Last Name:BREWER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 E MCKELLIPS RD
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85288-1303
Mailing Address - Country:US
Mailing Address - Phone:442-515-8077
Mailing Address - Fax:
Practice Address - Street 1:3700 N 24TH ST STE 230
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-6526
Practice Address - Country:US
Practice Address - Phone:602-903-4383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ033598225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist