Provider Demographics
NPI:1629161955
Name:BRENING, STEPHANIE RENEE (ATC/LAT)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:RENEE
Last Name:BRENING
Suffix:
Gender:F
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 1:2191 OLD HARRISON PIKE NW APT 2
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37311-1098
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1120 N OCOEE ST
Practice Address - Street 2:LEE UNIVERISTY ATHLETIC TRAINING
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311-4458
Practice Address - Country:US
Practice Address - Phone:423-614-8527
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00000010132255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer