Provider Demographics
NPI:1962643338
Name:BREMER, DAVE (PT)
Entity Type:Individual
Prefix:
First Name:DAVE
Middle Name:
Last Name:BREMER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5030 S. WESTWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:REPUBLIC
Mailing Address - State:MO
Mailing Address - Zip Code:65738
Mailing Address - Country:US
Mailing Address - Phone:417-235-8770
Mailing Address - Fax:417-235-8780
Practice Address - Street 1:5030 S WESTWOOD DR
Practice Address - Street 2:
Practice Address - City:REPUBLIC
Practice Address - State:MO
Practice Address - Zip Code:65738
Practice Address - Country:US
Practice Address - Phone:417-235-8770
Practice Address - Fax:417-235-8780
Is Sole Proprietor?:No
Enumeration Date:2009-03-16
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002004650225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist