Healthcare Provider Details

I. General information

NPI: 1982003174
Provider Name (Legal Business Name): BRETT A GLIEM PA-C, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2014
Last Update Date: 02/07/2025
Certification Date: 02/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 SW GARFIELD AVE
TOPEKA KS
66606-1670
US

IV. Provider business mailing address

901 SW GARFIELD AVE
TOPEKA KS
66606-1670
US

V. Phone/Fax

Practice location:
  • Phone: 785-354-9591
  • Fax: 785-368-0586
Mailing address:
  • Phone: 785-354-9591
  • Fax: 785-368-0586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2400833
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number15-02142
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: