Provider Demographics
NPI:1902123847
Name:BREUM, MA. AURORA DIAZ (PT)
Entity Type:Individual
Prefix:MRS
First Name:MA. AURORA
Middle Name:DIAZ
Last Name:BREUM
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 1:9 RIADA DR
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MT
Mailing Address - Zip Code:59044-9216
Mailing Address - Country:US
Mailing Address - Phone:406-628-8990
Mailing Address - Fax:
Practice Address - Street 1:9 RIADA DR
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MT
Practice Address - Zip Code:59044-9216
Practice Address - Country:US
Practice Address - Phone:406-628-8990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-03
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031008225100000X
MT2481225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist