Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 15814 | NC |
NPI | 1003288432 |
---|---|
Provider Name | Brent Edward Sammann |
First Address | Ooltewah, TN 37363-6511 |
Second Address | Pinehurst, NC 28374-6004 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2015 |
Last Update Date | 26/10/2015 |