Provider Demographics
NPI:1679026082
Name:BRINKLEY PATETA, ELIZABETH LOUISE (MA, ATC)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:LOUISE
Last Name:BRINKLEY PATETA
Suffix:
Gender:F
Credentials:MA, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2715 SEVERN DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503-2147
Mailing Address - Country:US
Mailing Address - Phone:775-690-0435
Mailing Address - Fax:
Practice Address - Street 1:10085 DOUBLE R BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-5860
Practice Address - Country:US
Practice Address - Phone:775-850-1888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-02
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV05061812255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer