Provider Demographics
NPI:1366455867
Name:BREWER, JUDY CAROLYN
Entity type:Individual
Prefix:
First Name:JUDY
Middle Name:CAROLYN
Last Name:BREWER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 MEDIUM CEMETERY RD
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:TN
Mailing Address - Zip Code:37144-7802
Mailing Address - Country:US
Mailing Address - Phone:931-438-8299
Mailing Address - Fax:
Practice Address - Street 1:117 WILLARD ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37334-3041
Practice Address - Country:US
Practice Address - Phone:931-438-8299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2665225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist