Provider Demographics
NPI:1205295987
Name:HOSTETLER, BRANDON L (PT, DPT)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:L
Last Name:HOSTETLER
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:813 KERMIT DR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37912-3861
Mailing Address - Country:US
Mailing Address - Phone:865-622-5043
Mailing Address - Fax:865-622-5066
Practice Address - Street 1:813 KERMIT DR
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37912-3861
Practice Address - Country:US
Practice Address - Phone:865-622-5043
Practice Address - Fax:865-622-5066
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-23
Last Update Date:2018-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10764225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty