Provider Demographics
NPI:1366417263
Name:NEU, BRIAN (MS, ATC, LAT)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:NEU
Suffix:
Gender:M
Credentials:MS, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12815 AUSTIN COVE CT
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-6364
Mailing Address - Country:US
Mailing Address - Phone:570-498-9924
Mailing Address - Fax:
Practice Address - Street 1:12815 AUSTIN COVE CT
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-6364
Practice Address - Country:US
Practice Address - Phone:570-498-9924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL 18392255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer