Provider Demographics
NPI:1316935083
Name:MILNARICH, BRIAN J (LAT)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:J
Last Name:MILNARICH
Suffix:
Gender:M
Credentials:LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N9642 COUNTY RD N
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54915-9312
Mailing Address - Country:US
Mailing Address - Phone:920-420-4371
Mailing Address - Fax:
Practice Address - Street 1:N496 MILKY WAY
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54915-3993
Practice Address - Country:US
Practice Address - Phone:920-420-4371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI556392255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer