Provider Demographics
NPI:1730818568
Name:PICONE, BRIANNA (MS, LAT, ATC)
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:
Last Name:PICONE
Suffix:
Gender:F
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:831 CORONADO CENTER DR APT 16111
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-4277
Mailing Address - Country:US
Mailing Address - Phone:951-500-4559
Mailing Address - Fax:
Practice Address - Street 1:4601 W BONANZA RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89107-2146
Practice Address - Country:US
Practice Address - Phone:951-500-4559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-07
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV05063772255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer