Healthcare Provider Details

I. General information

NPI: 1659899128
Provider Name (Legal Business Name): BRADY GEORGE ABOUSSLEMAN DPT, PT, AT, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2017
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7111 N FRESNO ST STE 100
FRESNO CA
93720-2959
US

IV. Provider business mailing address

1170 SANTA ANA AVE APT 130
CLOVIS CA
93612-4051
US

V. Phone/Fax

Practice location:
  • Phone: 559-878-5080
  • Fax:
Mailing address:
  • Phone: 906-250-5630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number308205
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: