Provider Demographics
NPI:1730379215
Name:BREMER, MATTHEW WILLIAM (PT)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:WILLIAM
Last Name:BREMER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:634 BARNES BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-5217
Mailing Address - Country:US
Mailing Address - Phone:321-351-2700
Mailing Address - Fax:321-351-2727
Practice Address - Street 1:634 BARNES BLVD
Practice Address - Street 2:STE 202
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-5217
Practice Address - Country:US
Practice Address - Phone:321-351-2700
Practice Address - Fax:321-351-2727
Is Sole Proprietor?:No
Enumeration Date:2007-07-31
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT22904225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist