Provider Demographics
NPI:1114389525
Name:BREHM, ROBERTA (DPT)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:
Last Name:BREHM
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5656
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93150-5656
Mailing Address - Country:US
Mailing Address - Phone:805-565-5252
Mailing Address - Fax:805-565-5250
Practice Address - Street 1:1470 E VALLEY RD
Practice Address - Street 2:SUITE M
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93108-1220
Practice Address - Country:US
Practice Address - Phone:805-565-5252
Practice Address - Fax:805-565-5250
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-24
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA291208225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist