Provider Demographics
NPI:1396743134
Name:BREWER, MARC CHRISTOPHER (PT)
Entity type:Individual
Prefix:MR
First Name:MARC
Middle Name:CHRISTOPHER
Last Name:BREWER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4440 GLEN ESTE WITHAMSVILLE RD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45245-1318
Mailing Address - Country:US
Mailing Address - Phone:513-794-3363
Mailing Address - Fax:513-753-4308
Practice Address - Street 1:4440 GLEN ESTE WITHAMSVILLE RD
Practice Address - Street 2:SUITE 500
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45245-1318
Practice Address - Country:US
Practice Address - Phone:513-794-3363
Practice Address - Fax:513-753-4308
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT-09206225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9342317OtherPHCS
OH000000328337OtherANTHEM
OH2455794Medicaid
P00288201OtherMEDICARE RAILROAD
OH000000328337OtherANTHEM
P99883Medicare UPIN
OH0225920002Medicare NSC
P00288201OtherMEDICARE RAILROAD