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Individual
JORDAN BREWER
Active
Individual
JORDAN BREWER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT27428
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12734214
CAQH
FL
01
—
Y0N0E
FLORIDA BLUE
FL
Enumeration date
06/13/2014
Last updated
02/13/2020
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