Provider Demographics
NPI:1750315248
Name:BRANTLEY, JERMAINE MONTREZ (RPT)
Entity Type:Individual
Prefix:MR
First Name:JERMAINE
Middle Name:MONTREZ
Last Name:BRANTLEY
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2841 BANYAN BOULEVARD CIR NW
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-6363
Mailing Address - Country:US
Mailing Address - Phone:561-988-5547
Mailing Address - Fax:561-496-5201
Practice Address - Street 1:13660 JOG RD
Practice Address - Street 2:SUITE B3
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33446-3806
Practice Address - Country:US
Practice Address - Phone:561-496-5144
Practice Address - Fax:561-496-5201
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 22634225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist