Provider Demographics
NPI:1700305356
Name:BREWER, TAYLOR SPEARMAN (DPT)
Entity type:Individual
Prefix:MRS
First Name:TAYLOR
Middle Name:SPEARMAN
Last Name:BREWER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MS
Other - First Name:TAYLOR
Other - Middle Name:LEE
Other - Last Name:SPEARMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:29 ALBERTA AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29403-3305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2060 NORTHBROOK BLVD STE 101
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9811
Practice Address - Country:US
Practice Address - Phone:843-797-5167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-14
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8163225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist