Provider Demographics
NPI:1497029128
Name:BANEY, BRIAN EMMET (ATC)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:EMMET
Last Name:BANEY
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2030 S PATRICK DR
Mailing Address - Street 2:STE 3
Mailing Address - City:INDIAN HARBOUR BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-4400
Mailing Address - Country:US
Mailing Address - Phone:321-773-5290
Mailing Address - Fax:321-773-5268
Practice Address - Street 1:2030 S PATRICK DR
Practice Address - Street 2:STE 3
Practice Address - City:INDIAN HARBOUR BEACH
Practice Address - State:FL
Practice Address - Zip Code:32937-4400
Practice Address - Country:US
Practice Address - Phone:321-773-5290
Practice Address - Fax:321-773-5268
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-27
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL5222255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer