Provider Demographics
NPI:1003288432
Name:SAMMANN, BRENT EDWARD (DPT)
Entity Type:Individual
Prefix:
First Name:BRENT
Middle Name:EDWARD
Last Name:SAMMANN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8823 PRODUCTION LN
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6511
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-285-6647
Practice Address - Street 1:246 OLMSTED BLVD
Practice Address - Street 2:STE D
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-6004
Practice Address - Country:US
Practice Address - Phone:910-235-0655
Practice Address - Fax:910-235-0665
Is Sole Proprietor?:No
Enumeration Date:2015-10-26
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15814225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist