Provider Demographics
NPI:1073198321
Name:MUNOZ, BREEANNA PRISCILLA (ATC)
Entity Type:Individual
Prefix:MS
First Name:BREEANNA
Middle Name:PRISCILLA
Last Name:MUNOZ
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 1:10020 TRAINSTATION CIR APT 338
Mailing Address - Street 2:
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-5365
Mailing Address - Country:US
Mailing Address - Phone:562-293-6097
Mailing Address - Fax:
Practice Address - Street 1:2168 FIELD HOUSE DR
Practice Address - Street 2:
Practice Address - City:USAF ACADEMY
Practice Address - State:CO
Practice Address - Zip Code:80840-9599
Practice Address - Country:US
Practice Address - Phone:719-333-8371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-17
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAT.00018102255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer