Provider Demographics
NPI:1568730133
Name:BREEDLOVE, CHAD WESELY (ATC)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:WESELY
Last Name:BREEDLOVE
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:108 PORTSMOUTH CV
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-1740
Mailing Address - Country:US
Mailing Address - Phone:615-256-1818
Mailing Address - Fax:615-256-6884
Practice Address - Street 1:821 FESSLERS PKWY
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37210-2902
Practice Address - Country:US
Practice Address - Phone:615-256-1818
Practice Address - Fax:615-256-6884
Is Sole Proprietor?:No
Enumeration Date:2011-12-09
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer