Provider Demographics
NPI:1386136125
Name:BREWER, JACOBY (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:JACOBY
Middle Name:
Last Name:BREWER
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2554 GROVE PARK WAY
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-1586
Mailing Address - Country:US
Mailing Address - Phone:931-332-3541
Mailing Address - Fax:
Practice Address - Street 1:321 DEXTER L WOODS MEMORIAL BLVD STE 3
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:TN
Practice Address - Zip Code:38485-2418
Practice Address - Country:US
Practice Address - Phone:931-332-3541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-06
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11817225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist