Provider Demographics
NPI:1518403476
Name:SIMPSON, BRENT
Entity Type:Individual
Prefix:
First Name:BRENT
Middle Name:
Last Name:SIMPSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 STONEBROOK PL
Mailing Address - Street 2:STE B
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-3652
Mailing Address - Country:US
Mailing Address - Phone:731-664-7060
Mailing Address - Fax:731-664-5005
Practice Address - Street 1:85 STONEBROOK PL
Practice Address - Street 2:STE B
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-3652
Practice Address - Country:US
Practice Address - Phone:731-664-7060
Practice Address - Fax:731-664-5005
Is Sole Proprietor?:No
Enumeration Date:2017-01-16
Last Update Date:2017-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5423225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant