Provider Demographics
NPI:1730196676
Name:BREWER, EARL EDWARD (BS-PHYSIAL THERAPY)
Entity type:Individual
Prefix:MR
First Name:EARL
Middle Name:EDWARD
Last Name:BREWER
Suffix:
Gender:M
Credentials:BS-PHYSIAL THERAPY
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Mailing Address - Street 1:11711 NE 12TH ST
Mailing Address - Street 2:SUITE 3A
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005
Mailing Address - Country:US
Mailing Address - Phone:425-450-9474
Mailing Address - Fax:425-635-9340
Practice Address - Street 1:3801 5TH STREET SE
Practice Address - Street 2:SUITE 220
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98374
Practice Address - Country:US
Practice Address - Phone:253-445-4258
Practice Address - Fax:253-445-4724
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAPT00005124225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8341125Medicaid
LI0180089OtherLABOR & INDUSTRIES
LI0180089OtherLABOR & INDUSTRIES