Provider Demographics
NPI:1699915629
Name:BREWER, LAURA BAKER (PT)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:BAKER
Last Name:BREWER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4417 GRAYWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90808-1321
Mailing Address - Country:US
Mailing Address - Phone:562-607-4417
Mailing Address - Fax:
Practice Address - Street 1:4417 GRAYWOOD AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90808-1321
Practice Address - Country:US
Practice Address - Phone:562-607-4417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-04
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT11465225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist