Provider Demographics
NPI:1427392422
Name:FLEISHMAN, BRANDEN JEROLD (DPT)
Entity Type:Individual
Prefix:
First Name:BRANDEN
Middle Name:JEROLD
Last Name:FLEISHMAN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:112 BRADFORD BLVD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:GORDONSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38563-4600
Mailing Address - Country:US
Mailing Address - Phone:615-683-3010
Mailing Address - Fax:615-683-3016
Practice Address - Street 1:5003 CROSSINGS CIR
Practice Address - Street 2:SUITE 103
Practice Address - City:MOUNT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-8567
Practice Address - Country:US
Practice Address - Phone:615-288-8936
Practice Address - Fax:615-288-8938
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAPT022456225100000X
TN11133225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist