Provider Demographics
NPI:1780765925
Name:BREWER, BRUCE G (PT, MSPT, CMTPT)
Entity type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:G
Last Name:BREWER
Suffix:
Gender:M
Credentials:PT, MSPT, CMTPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 69030
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-9030
Mailing Address - Country:US
Mailing Address - Phone:757-873-2306
Mailing Address - Fax:757-873-2306
Practice Address - Street 1:3100 W MARSHALL ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-4706
Practice Address - Country:US
Practice Address - Phone:804-342-5857
Practice Address - Fax:804-355-0408
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305201809225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP00177776OtherMEDICARE RAILROAD
VA225579OtherBCBS PHYSICAL THERAPY
VA010061512Medicaid
VA7900156OtherAETNA
VA225579OtherBCBS PHYSICAL THERAPY
VA010061512Medicaid