Provider Demographics
NPI:1174939029
Name:BREWER, MATTHEW (MS, ATC-R)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:BREWER
Suffix:
Gender:M
Credentials:MS, ATC-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3820 S DELAWARE ST
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80110-3514
Mailing Address - Country:US
Mailing Address - Phone:303-929-7424
Mailing Address - Fax:
Practice Address - Street 1:3820 S DELAWARE ST
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80110-3514
Practice Address - Country:US
Practice Address - Phone:303-929-7424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-10
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAT.00006912255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer