Provider Demographics
NPI:1710623376
Name:BRINEY, MARANDA (MPH, AT, ATC)
Entity Type:Individual
Prefix:
First Name:MARANDA
Middle Name:
Last Name:BRINEY
Suffix:
Gender:F
Credentials:MPH, AT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22510 E INDIANA AVE
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-2173
Mailing Address - Country:US
Mailing Address - Phone:949-572-3782
Mailing Address - Fax:
Practice Address - Street 1:22510 E INDIANA AVE
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142-2173
Practice Address - Country:US
Practice Address - Phone:949-572-3782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-06
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0015312255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer