Provider Demographics
NPI:1871067694
Name:FIELDS, BRENTON MATTHEW (LAT, ATC)
Entity type:Individual
Prefix:
First Name:BRENTON
Middle Name:MATTHEW
Last Name:FIELDS
Suffix:
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 PHYSICIANS WAY STE 110
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37090-8107
Mailing Address - Country:US
Mailing Address - Phone:615-547-6700
Mailing Address - Fax:
Practice Address - Street 1:100 PHYSICIANS WAY STE 110
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37090-8107
Practice Address - Country:US
Practice Address - Phone:615-547-6700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-15
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer