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NPI Code Detail

MEDICARE: NATE BREMER PT, DPT

MEDICARE: NATE BREMER PT, DPT
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
1225100000XPhysical Therapist5501018990MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
15501018990OTHERMISTATE LICENSE

General Provider Information

NPI Number : 1407320203
Entity Type Code : Individual
Provider Name (Legal Business Name) : NATE BREMER PT, DPT
Provider Business Mailing Address
First Line : 33900 HARPER AVE STE 104
Second Line :
City : CLINTON TWP
State : MI
Zip : 48035-4258
Country : US
Telephone Number : 586-350-2644
Fax Number :
Provider Business Practice Location Address
First Line : 32934 WOODWARD AVE
Second Line :
City : ROYAL OAK
State : MI
Zip : 48073-0957
Country : US
Telephone Number : 248-554-9201
Fax Number : 248-554-9202
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/15/2019
Last Update Date : 02/27/2025

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