Provider Demographics
NPI:1659899128
Name:ABOUSSLEMAN, BRADY GEORGE (DPT, PT, AT, ATC)
Entity type:Individual
Prefix:
First Name:BRADY
Middle Name:GEORGE
Last Name:ABOUSSLEMAN
Suffix:
Gender:M
Credentials:DPT, PT, AT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1170 SANTA ANA AVE APT 130
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93612-4051
Mailing Address - Country:US
Mailing Address - Phone:906-250-5630
Mailing Address - Fax:
Practice Address - Street 1:7111 N FRESNO ST STE 100
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-2959
Practice Address - Country:US
Practice Address - Phone:559-878-5080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-05
Last Update Date:2025-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X
CA308205225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer