Provider Demographics
NPI:1972150266
Name:BREMMER, KAYLA JEAN (PT, DPT)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:JEAN
Last Name:BREMMER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22731 NEWMAN ST STE 200
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-2023
Mailing Address - Country:US
Mailing Address - Phone:313-982-0200
Mailing Address - Fax:313-982-0500
Practice Address - Street 1:22731 NEWMAN ST STE 200
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-2023
Practice Address - Country:US
Practice Address - Phone:313-982-0200
Practice Address - Fax:313-982-0500
Is Sole Proprietor?:No
Enumeration Date:2019-08-21
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14798-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist