Provider Demographics
NPI:1033108675
Name:BREHM-HEITMAN, KATHLEEN ANDREA (PT)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:ANDREA
Last Name:BREHM-HEITMAN
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 1:1402 SPRUCE DR
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS AFB
Mailing Address - State:ND
Mailing Address - Zip Code:58204-1462
Mailing Address - Country:US
Mailing Address - Phone:701-747-5555
Mailing Address - Fax:
Practice Address - Street 1:1402 SPRUCE DR
Practice Address - Street 2:
Practice Address - City:GRAND FORKS AFB
Practice Address - State:ND
Practice Address - Zip Code:58204-1462
Practice Address - Country:US
Practice Address - Phone:701-747-5555
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT007056L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist