Provider Demographics
NPI:1598318289
Name:SOUTH, BRITANY L (MS, LAT, ATC)
Entity type:Individual
Prefix:
First Name:BRITANY
Middle Name:L
Last Name:SOUTH
Suffix:
Gender:F
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:BRITANY
Other - Middle Name:L
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2720 HIDDEN SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75181-4018
Mailing Address - Country:US
Mailing Address - Phone:214-732-8664
Mailing Address - Fax:
Practice Address - Street 1:2720 HIDDEN SPRINGS DR
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75181-4018
Practice Address - Country:US
Practice Address - Phone:214-732-8664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-22
Last Update Date:2021-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X, 390200000X
TXAT84042255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty