Provider Demographics
NPI:1366629354
Name:BREWER, JANI L (MSPT)
Entity type:Individual
Prefix:
First Name:JANI
Middle Name:L
Last Name:BREWER
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:JANI
Other - Middle Name:L
Other - Last Name:SCHRAMM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:302 US HIGHWAY 68 W
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:KY
Mailing Address - Zip Code:42025-9499
Mailing Address - Country:US
Mailing Address - Phone:270-252-7600
Mailing Address - Fax:270-252-7602
Practice Address - Street 1:302 US HIGHWAY 68 W
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:KY
Practice Address - Zip Code:42025
Practice Address - Country:US
Practice Address - Phone:270-252-7600
Practice Address - Fax:270-252-7602
Is Sole Proprietor?:No
Enumeration Date:2008-01-22
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100371360Medicaid