Provider Demographics
NPI:1982003174
Name:GLIEM, BRETT A (PA-C, ATC)
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:A
Last Name:GLIEM
Suffix:
Gender:M
Credentials:PA-C, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 SW GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66606-1670
Mailing Address - Country:US
Mailing Address - Phone:785-354-9591
Mailing Address - Fax:785-368-0586
Practice Address - Street 1:901 SW GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66606-1670
Practice Address - Country:US
Practice Address - Phone:785-354-9591
Practice Address - Fax:785-368-0586
Is Sole Proprietor?:No
Enumeration Date:2014-08-14
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS24008332255A2300X
KS15-02142363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer