Provider Demographics
NPI:1972621290
Name:BREMNER, HEIDI (PT)
Entity Type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:
Last Name:BREMNER
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 1:604 N SEPULVEDA BLVD
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-5921
Mailing Address - Country:US
Mailing Address - Phone:310-374-0477
Mailing Address - Fax:310-374-1605
Practice Address - Street 1:604 N SEPULVEDA BLVD
Practice Address - Street 2:
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-5921
Practice Address - Country:US
Practice Address - Phone:310-374-0477
Practice Address - Fax:310-374-1605
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT222212251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT22221AMedicare UPIN