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General NPI Number Information
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NPI Number | 1962643338
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Entity Type | Individual
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Provider Name | DAVE BREMER P.T.
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Gender | Male
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Dates
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Enumeration Date | 03/16/2009
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Last Update Date | 05/22/2020
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Provider Practice Location Address
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Address Line | 5030 S WESTWOOD DR
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City | REPUBLIC
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State | MO
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Zip | 65738
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Country | US
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Telephone | 417-235-8770
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Fax | 417-235-8780
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Provider Business Mailing Address
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Address Line | 5030 S. WESTWOOD DRIVE
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City | REPUBLIC
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State | MO
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Zip | 65738
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Country | US
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Telephone | 417-235-8770
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Fax | 417-235-8780
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2002004650
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License Number State | MO
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