Brendan Joseph Menietti
Specialist/Technologist, Athletic Trainer in Breese, IL. Individual provider (NPI-1).
NPI number1669936712
StatusActive
Last updated in NPPESJan 23, 2019
Details
- NPI
- 1669936712
- Entity type
- Individual (NPI-1)
- Name
- Brendan Joseph Menietti
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Jan 23, 2019
- Last updated
- Jan 23, 2019
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 2255A2300X | Specialist/Technologist, Athletic Trainer | – | – | Yes |
Practice location
876 N 5th StBreese, IL 62230-1330
Phone 618-977-0042
Mailing address
876 N 5th StBreese, IL 62230-1330
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