Provider Demographics
NPI:1740241611
Name:HOLLIS, BRANDON K (PT, LATC)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:K
Last Name:HOLLIS
Suffix:
Gender:M
Credentials:PT, LATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 PATTERSON ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1562
Mailing Address - Country:US
Mailing Address - Phone:731-234-4962
Mailing Address - Fax:615-329-4469
Practice Address - Street 1:2400 PATTERSON ST
Practice Address - Street 2:SUITE 100
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1562
Practice Address - Country:US
Practice Address - Phone:615-324-0065
Practice Address - Fax:615-329-4469
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6042225100000X
FLPT 29055225100000X
FLAL 37912255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4223131OtherBCBS
TN3646021OtherMEDICARE PTAN