MEDICARE: MRS. HEIDI BREMNER PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251S0007X	Sports Physical Therapist	PT22221	CA

General Provider Information

NPI Number	:	1972621290
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HEIDI BREMNER PT

Provider Business Mailing Address
First Line	:	604 N SEPULVEDA BLVD
Second Line	:
City	:	MANHATTAN BEACH
State	:	CA
Zip	:	90266-5921
Country	:	US
Telephone Number	:	310-374-0477
Fax Number	:	310-374-1605

Provider Business Practice Location Address
First Line	:	604 N SEPULVEDA BLVD
Second Line	:
City	:	MANHATTAN BEACH
State	:	CA
Zip	:	90266-5921
Country	:	US
Telephone Number	:	310-374-0477
Fax Number	:	310-374-1605

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/26/2007
Last Update Date	:	12/02/2021

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