Provider Demographics
NPI:1265115315
Name:THOMAS, BRAXTIN LEE
Entity type:Individual
Prefix:
First Name:BRAXTIN
Middle Name:LEE
Last Name:THOMAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:713 RIVER LANDING WAY
Mailing Address - Street 2:
Mailing Address - City:OLD HICKORY
Mailing Address - State:TN
Mailing Address - Zip Code:37138-3832
Mailing Address - Country:US
Mailing Address - Phone:615-506-0645
Mailing Address - Fax:
Practice Address - Street 1:800 16TH AVE SE
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-6781
Practice Address - Country:US
Practice Address - Phone:888-223-4287
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist