=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265424071
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BREM PHYSICAL THERAPY ASSOCIATES, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/17/2005
-----------------------------------------------------
Last Update Date | 10/31/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8503 BROADWAY ST SUITE 113
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78217-6330
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-821-6100
-----------------------------------------------------
Fax | 210-821-6145
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8503 BROADWAY ST SUITE 113
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78217-6330
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-821-6100
-----------------------------------------------------
Fax | 210-821-6145
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/THERAPIST
-----------------------------------------------------
Name | MRS. BARBARA ELLEN BREM
-----------------------------------------------------
Credential | P.T.
-----------------------------------------------------
Telephone | 210-821-6100
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 1039139
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------