MEDICARE: MR. WILLIAM STUART BREMILLER MS MDT SCMT

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	225100000X	Physical Therapist	003455	CT
2	225100000X	Physical Therapist	010882	NY

General Provider Information

NPI Number	:	1023005485
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WILLIAM STUART BREMILLER MS MDT SCMT

Provider Business Mailing Address
First Line	:	1311 MAMARONECK AVE STE 140
Second Line	:
City	:	WHITE PLAINS
State	:	NY
Zip	:	10605-5224
Country	:	US
Telephone Number	:	914-294-4050
Fax Number	:

Provider Business Practice Location Address
First Line	:	2 FRONT ST
Second Line	:
City	:	MILLBROOK
State	:	NY
Zip	:	12545
Country	:	US
Telephone Number	:	845-677-5021
Fax Number	:	845-677-3117

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

Provider Enumeration Date	:	09/30/2005
Last Update Date	:	05/11/2022

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