Provider Demographics
NPI:1588766091
Name:MARR, BRIAN E (ATC,LAT)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:E
Last Name:MARR
Suffix:
Gender:M
Credentials:ATC,LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31219 MAJESTIC PARK LN
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77386-2026
Mailing Address - Country:US
Mailing Address - Phone:281-681-9041
Mailing Address - Fax:
Practice Address - Street 1:22603 NORTHCREST DR
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77389-4451
Practice Address - Country:US
Practice Address - Phone:832-484-4805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT13572255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer