Provider Demographics
NPI:1891784716
Name:BREUER, ANDREA J (PT)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:J
Last Name:BREUER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:J
Other - Last Name:SWARTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:25 HERITAGE WAY
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-3100
Mailing Address - Country:US
Mailing Address - Phone:406-407-7990
Mailing Address - Fax:
Practice Address - Street 1:1111 BAKER AVE UPPR LEVEL
Practice Address - Street 2:
Practice Address - City:WHITEFISH
Practice Address - State:MT
Practice Address - Zip Code:59937-2901
Practice Address - Country:US
Practice Address - Phone:406-862-2670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT405225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTMT STATE FUND COMPOtherPROVIDER #
MT0343226Medicaid
MTBCBS OF MTOtherPROVIDER #
MTWA STATE WORK COMPOtherPROVIDER# WA COMP PATIENT
MT0343226Medicaid