Provider Demographics
NPI:1124500970
Name:BREWER, NATASHIA PAIGE (PTA)
Entity type:Individual
Prefix:
First Name:NATASHIA
Middle Name:PAIGE
Last Name:BREWER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 42ND ST SE
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75462-8631
Mailing Address - Country:US
Mailing Address - Phone:903-272-4657
Mailing Address - Fax:
Practice Address - Street 1:150 47TH ST SE
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75462-7417
Practice Address - Country:US
Practice Address - Phone:903-784-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-29
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2065471225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant