Provider Demographics
NPI:1043677909
Name:BREYMEIER, MARISSA MARIE (ATC)
Entity Type:Individual
Prefix:MISS
First Name:MARISSA
Middle Name:MARIE
Last Name:BREYMEIER
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 STONEY HILL LN
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-2903
Mailing Address - Country:US
Mailing Address - Phone:609-304-3923
Mailing Address - Fax:
Practice Address - Street 1:19 STONEY HILL LN
Practice Address - Street 2:
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-2903
Practice Address - Country:US
Practice Address - Phone:609-304-3923
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-24
Last Update Date:2016-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0061532255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer