Provider Demographics
NPI:1265424071
Name:BREM PHYSICAL THERAPY ASSOCIATES, PC
Entity type:Organization
Organization Name:BREM PHYSICAL THERAPY ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:BREM
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:210-821-6100
Mailing Address - Street 1:8503 BROADWAY ST
Mailing Address - Street 2:SUITE 113
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-6330
Mailing Address - Country:US
Mailing Address - Phone:210-821-6100
Mailing Address - Fax:210-821-6145
Practice Address - Street 1:8503 BROADWAY ST
Practice Address - Street 2:SUITE 113
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-6330
Practice Address - Country:US
Practice Address - Phone:210-821-6100
Practice Address - Fax:210-821-6145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-17
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1039139174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX86779TOtherBLUE CROSS BLUE SHIELD
TX00794TMedicare ID - Type Unspecified