Provider Demographics
NPI:1518332162
Name:JONSSON, BRENDON MICHAEL (MS, ATC, LAT)
Entity Type:Individual
Prefix:
First Name:BRENDON
Middle Name:MICHAEL
Last Name:JONSSON
Suffix:
Gender:M
Credentials:MS, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4901 DAWN DR
Mailing Address - Street 2:SUITE 2300
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28360-8287
Mailing Address - Country:US
Mailing Address - Phone:910-738-1065
Mailing Address - Fax:
Practice Address - Street 1:4901 DAWN DR
Practice Address - Street 2:SUITE 2300
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28360-8287
Practice Address - Country:US
Practice Address - Phone:910-738-1065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-08
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLAT-23992255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer