Healthcare Provider Details

I. General information

NPI: 1588766091
Provider Name (Legal Business Name): BRIAN E MARR ATC,LAT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22603 NORTHCREST DR
SPRING TX
77389-4451
US

IV. Provider business mailing address

31219 MAJESTIC PARK LN
SPRING TX
77386-2026
US

V. Phone/Fax

Practice location:
  • Phone: 832-484-4805
  • Fax:
Mailing address:
  • Phone: 281-681-9041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT1357
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: