Provider Demographics
NPI:1194777664
Name:BREWER, SANDRA D (PT)
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:D
Last Name:BREWER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:SANDRA
Other - Middle Name:
Other - Last Name:JOHNSON-BREWER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 32709
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37930-2709
Mailing Address - Country:US
Mailing Address - Phone:865-558-6484
Mailing Address - Fax:865-584-4037
Practice Address - Street 1:11426 KINGSTON PIKE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934-3915
Practice Address - Country:US
Practice Address - Phone:865-966-8933
Practice Address - Fax:865-966-5488
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6891225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4076074OtherBLUE CROSS
TNCH4394OtherMEDICARE-RAILROAD GROUP ID
TN3658710Medicaid
TN3658710Medicare ID - Type Unspecified