Basic Information
| Provider Information | |||||||||
| NPI: | 1487842639 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRANDT | ||||||||
| FirstName: | TREVOR | ||||||||
| MiddleName: | BENJAMIN | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 681478 | ||||||||
| Address2: | |||||||||
| City: | FRANKLIN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370681478 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8668009147 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 121 VILLAGE DR | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | PORTLAND | ||||||||
| State: | TN | ||||||||
| PostalCode: | 371481418 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153237575 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/11/2007 | ||||||||
| LastUpdateDate: | 10/11/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.