Provider Demographics
NPI:1023412087
Name:WELLS, BRANDON (MS, LAT, ATC, CSCS)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:WELLS
Suffix:
Gender:M
Credentials:MS, LAT, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 JESS NEELY DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37212-2039
Mailing Address - Country:US
Mailing Address - Phone:435-227-6081
Mailing Address - Fax:
Practice Address - Street 1:2601 JESS NEELY DR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-2039
Practice Address - Country:US
Practice Address - Phone:615-322-8769
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-20
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN23642255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN2364OtherSTATE OF TENNESSEE DIVISION OF HEALTH RELATED BOARDS