Provider Demographics
NPI:1174702658
Name:BREM, BARBARA (PT)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:BREM
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8503 BROADWAY ST
Mailing Address - Street 2:113
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-6330
Mailing Address - Country:US
Mailing Address - Phone:210-821-6100
Mailing Address - Fax:210-821-6145
Practice Address - Street 1:8503 BROADWAY ST
Practice Address - Street 2:113
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-6330
Practice Address - Country:US
Practice Address - Phone:210-821-6100
Practice Address - Fax:210-821-6145
Is Sole Proprietor?:No
Enumeration Date:2007-10-31
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1039139174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8612B7Medicare PIN